Ocular Disease: Lecture14: Conjuntiva Flashcards
Conjunctiva
- It’s Highly Vascular: What 2 arteries supply blood to it?
- It has a dense lymph system. Drains to what 2 areas?
- Anterior Ciliary Arteries, and Palpebral Arteries
2. Pre-auricular and Submandibular
Conjunctiva: Important Findings
Discharge
- What 4 types of discharge are there?
- Watery (Serous), Mucous, Mucopurulent, and Purulent Discharge
Conjunctiva: Important Findings
Discharge: Watery (Serous)
- What 2 things can cause it?
- Mucous Discharge: What 2 things can cause it?
- Acute Viral Conjunctivitis and Acute Allergic Conjunctivitis
- Chronic Allergic Conjunctivitis, and Dry Eye
Conjunctiva: Important Findings
Discharge: Mucopurulent
- What 2 things can cause it?
- Purulent Dishcarge
a. Moderate caused by what?
b. Severe Caused by what?
- Acute Bacterial Conjunctivitis, and Chlamydia
- a. Acute Bacterial Conjunctivitis
b. Gonococcal
Conjunctiva: Important Findings
- Hyperemia (Injection): Caused by what?
- Hemorrhage: Caused by what 3 things?
- Ocular Irritation
- a. Trauma
b. Bacterial and Viral Conjunctivitis
Conjunctiva: Important Findings
Chemosis (Edema)
- 2 symptoms seen with it?
- If it’s severe, how will it present?
- Acute (Non-Traumautic): Caused by what?
- Chronic: Caused by what?
- Severe Inflammation and Translucent Swelling
- It will Protrude through the Lids
- Hypersensitivity
- Orbital Outflow Restrictions
Conjunctiva: Important Findings
Membranes
- 2 Types
- Can be due to what 5 issues?
- Pseudomembranes and True Membranes
- a. Bacterial Infections
b. Gonococcal Conjunctivitis
c. Ligneous Conjunctivitis
d. Severe Adenoviral Conjunctivitis
e. Stevens Johnson Syndrome
Conjunctiva: Important Findings
Pseudomembranes
- What are they?
- What do they “STICK” to?
- They can be peeled…if so, what will happen?
- Coagulated Exudates
- Inflamed Conjunctival Epithelium
- Cause Bleeding
Conjunctiva: Important Findings
True Membranes
- Involve what layers?
- What will it tear when you try to remove them?
- Superficial Layers
2. Tears Conjunctiva when you try to remove them.
Conjunctiva: Important Findings
Infiltration
- Due to what?
- What does it look like?
a. This obscures what?
- Due to Chronic Inflammation
- a Whitish Clouding of the Conjunctiva
a. the Underlying Structures
Conjunctiva: Important Findings
Follicles
- What are they?
- Are they a solid color or translucent?
- Where are they most prominent?
a. IF they’re FOUND at the LIMBAL, what causes it? - How are vessels found on them?
- Multiple, Discrete, Slightly Elevated Lesions
- Translucent
- In the FORNIX
a. Chlamydia - They Run ACROSS or AROUND them, instead of WITHIN them.
Conjunctiva: Important Findings
Follicles
- Due to what 4 infections?
- Normal found how in Children?
- Normally found how in Adults?
- a. Chlamydial Conjunctivitis
b. Viral Conjunctivitis
c. Medicamentosa
d. Parinaud Oculoglandular Syndrome - Small follicles in children are normal
- Small Follicles AT FORNICES and MARGIN of UPPER TARSAL PLATE for Adults
Conjunctiva: Important Findings
Papillae
- Found in 1 of 2 places only?
- Macropapillae: Size?
- Giant Papillae: Size?
- What kind of CORE do they have?
- Palpebral or Limbal Bulbar Conjunctiva
- Less than 1 mm
- Greater than 1 mm
- Vascular Core
Conjunctiva: Important Findings
Papillae
- Can be caused by what 7 things?
- Allergic Conjunctivitis
- Bacterial Conjunctivitis
- Chlamydial Conjunctivitis
- Chronic Marginal Blepharitis
- Contact Lens wear
- Floppy Eyelid Syndrome
- SLK
Conjunctiva: Important Findings
Phlyctenulosis
We already talked about this…see previous lecture slides!
Conjunctival Degenerations
4 things to know?
- Concretions
- Conjunctivochalasis
- Pinguecula (Review from last lecture)
- Retention Cyst (Conjunctival Inclusion Cyst)
Conjunctival Degenerations: Concretions
- How common are they?
- Uni or Bilateral?
- Associated with what 2 things?
- VERY COMMON
- Usually Bilateral
- Aging (most of the time) and Chronic Conjunctival Inflammation
Conjunctival Degenerations: Concretions
- What are they?
a. Made up of what 2 things? - Where are they found?
- Multiple Tiny Yellowish White Deposits
a. Epithelial Debris and Keratin - Subepithelial Conjunctiva (Forniceal and Inferior Palpebral)
Conjunctival Degenerations: Concretions
- What can they become?
- What might they ERODE?
a. This will lead to what?
- Calcified
- Overlying Epithelium
a. Ocular Irritation
Conjunctival Degenerations: Concretions
Treatment
- If Asymptomatic?
- If Symptomatic?
- None. Just Monitor
2. Topical Anesthetic. Remove them.
Conjunctival Degenerations: Conjunctivochalasis
- How common are they?
- What are they associated with? (1)
a. They’re exacerbated by what?
- Relatively Common
- AGING
a. by Posterior Lid Margin Disease
Conjunctival Degenerations: Conjunctivochalasis
- Signs: What is Noted b/w the Globe and the Lower Lid?
a. May note staining with what? - Symptoms (2/3)
- Fold of Redundant Conjunctiva
a. Rose Bengal - Epiphora (Secondary Punctal Stenosis: Mechanical Obstruction of Inferior Punctum)
and
Possible FBS on Downgaze
Conjunctival Degenerations: Conjunctivochalasis
Treatment
- What 4 things can be done to treat it?
- Lubrication
- Conjunctival Resection if it’s severe enough
- Manage Secondary Conditions (Blepharitis)
- Topical Steroids if it’s Inflamed
Conjunctival Degenerations: Conjunctival Retention Cyst (Conjunctival Inclusion Cyst)
- How common is it?
- Sign?
- Fluid can be what 2 things?
- What 2 locations of the conj is it found?
- VERY COMMON
- Thin walled (Translucent) fluid filled cyst
- Clear and Turbid
- Bulbar or Palpebral Conjunctiva
Conjunctival Degenerations: Conjunctival Retention Cyst (Conjunctival Inclusion Cyst)
- Symptoms?
- Treatment?
- Usually none. Sometimes a Cosmetic Concern
2. Usually None. You can puncture it with a Needle
Benign Conjunctival Lesions
- 5 discussed in class…
- Conjunctival Nevus
- Conjunctival Epithelial Melanosis
- Dermoid
- Dermolipoma
- Pyogenic Granuloma
Benign Conjunctival Lesions: Conjunctival Naevus
- MOST COMMON what?
- 1% chance that what will happen?
- When does it present?
- Melanocytic Conjunctival Tumor
- of Malignant Transformation
- 1st-2nd Decade
Benign Conjunctival Lesions: Conjunctival Naevus
Signs
- Type of Lesion?
a. Where is it Located?
b. Size?
c. Most common locations? (3)
- Solitary, UNILATERAL, Discrete, Mildly elevated intraepithelial Lesions
a. on Bulbar Conjunctiva
b. Variable
c. Caruncle, Juxtalimbal, and Plica
Benign Conjunctival Lesions: Conjunctival Naevus
Signs (2)
- Pigmentation?
- May have what kind of space?
- What can it become in children and adolescents?
- Variable. (Non-pigmented is also Possible)
- Cystic Spaces
- Pink and Congested
Benign Conjunctival Lesions: Conjunctival Naevus
Signs of Potential Malignancy
- 4 things?
- Unusual Location (Palpebral Conj or Fornix)
- Prominent FEEDER VESSEL
- Sudden Growth or Change in Pigmentation
- Adult Age Development
Benign Conjunctival Lesions: Conjunctival Naevus
Treatment?
- Excision
a. COSMETIC is the main reason
b. Irritation
c. Suspicious Appearance
Benign Conjunctival Lesions: Conjunctival Dermoid
- How common is it?
- When does it appear?
- What is it?
- 2 Systemic Associations?
- Uncommon
- Early Childhood. (CONGENITAL)
- Solid Mass. Made of COLLAGENOUS TISSUE (Dermal Elements)
- Goldenhar Syndrome, and Linear Nevus Sebaceus of Jadassohn
Benign Conjunctival Lesions: Conjunctival Dermoid
Signs
- It’s a Subconjunctival Mass. (what 4 things does it appear like)
a. What may protrude from it? - Where is it located at? (most commonly)
a. May encompass what?
- Smooth, Soft, Yellowish white subconjunctival mass.
a. Hair - Inferotemporal Limbus
a. the Entire Limbus (Complex Choristoma)
Benign Conjunctival Lesions: Conjunctival Dermoid
Treatment
- Indicated for what 3 things?
- Small Lesion: What do u do?
- Large Lesion: What do you do?
- Cosmetic Reason; Chronic Irritation. Amblyopia (Astigmatism, and Involves Visual Axis)
- Excision
- Lamellar Keratosclerectomy
Benign Conjunctival Lesions: Dermolipoma
- How common is it?
- Uni or Bi?
- Presents when?
- Similar to what?
a. has what tissue in it?
- Uncommon
- Bilateral
- In ADULTHOOD (Congenital)
- Dermoid
a. Fatty Tissue
Benign Conjunctival Lesions: Dermolipoma
Signs
- Subconjunctival Mass….like what?
- Location?
a. Can extend into what?
b. Hard to see what?
- Soft, Movable, Yellowish-TAN Subconjunctival Mass
a. May have hair protruding - Superior Temporally Near Outer Canthus
a. Into Superior Fornix
b. the Posterior Limit