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Conjunctiva Flashcards

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1
Q

Parts of conjunctiva

A
  1. Palpebral - Orbital, Tarsal, Marginal
  2. Bulbar
  3. Forniceal

Histo:
1.Epithelium

  1. Adenoid layer
  2. Fibrous layer
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2
Q

2 specialised membranes in conjunctiva

A
  1. Pelican semilunaris

2. Caruncle

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3
Q

Cells present in epithelium of conjunctiva

A
  1. Goblet cells
  2. Melanocytes
  3. Langerhan cells
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4
Q

Goblet cells form which part of tear film

A

Mucin layer of tear film

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5
Q

Only part of eye which has LYMPHATIC drainage

A

CONJUNCTIVA

Medial - Submandibular LN

Lateral - Preauricular nd superficial parotid LN

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6
Q

Significance of adenoid layer of conjunctiva

A

It consists of lymphoid tissue which shows follicular reaction.

It develops only after 3 months….so no rn in infants.

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7
Q

Glands seen in conjunctiva

A
  1. Mucin secreting = Goblet cells, Crypts of Henle, Glands of Manz
  2. Accessory lacrimal= Glands of Krause, Glands of Wolfring
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8
Q

Arterial supply of conjunctiva

A

1.Peripheral arterial arcade of eyelid - palpebral nd fornix

2.Marginal arterial arcade—> Post conj A.— bulbar
Anterior ciliary artery —>Ant conj A.—— “

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9
Q

Common symptoms of conjunctivitis

A
  1. Redness
  2. Discharge
  3. FBS
  4. Lacrimation
  5. Itching….mainly in allergic

***If pain nd loss of vision +nt=> corneal involved

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10
Q

Common signs of conjunctivitis

A
  1. Hyperemia
  2. Subconj Hmg
  3. Chemosis
  4. Discharge
  5. Inflammatory rn= papillae or follicles
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11
Q

Coloured halos are seen in?

A
  1. Glaucoma
  2. Cataract
  3. Mucopurulent conjunctivitis
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12
Q

Papillary Follicular

MP 1 2

Watery 3 4

A

1= Bacterial

2= Chlamydial

3= Allergic

4= Viral

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13
Q

MCC of Acute bacterial conjunctivitis

Specific symptoms

A

Staph aureus

Assoc with Mucopurulent discharge nd coloured halos

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14
Q

Epidemics of MP conjunctivitis or Red eye are caused by?

A

Hemophilus influenza or KOCH-WEEKS bacillus

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15
Q

Treatment for Acute conjunctivitis

A

1% chloramphenicol or 0.3%Tobramycin

If not respond - cipro0.3% or moxi0.5%.

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16
Q

Acute purulent or Hyperacute conjunctivitis
Cause?
Symptoms?
Signs?

A

Aka Blenorrhoea
*caused by N.gonorrhoea

Symptoms

  1. Copies purulent discharge
  2. Intense pain***
  3. Stickiness,PP

Signs

  1. Swollen eyelids
  2. Conj-chemosis nd congestion= Bright red velvety*
  3. Pseudomembrane formation freq
  4. Preauricular LA***
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17
Q

Treatment for Acute purulent conjunctivitis

A

1.Systemic - IM ceftriaxone 1g /Norfloxacin 1g for 5 days
+
Erythromycin 500mg or Doxycycline 100mg for 1 week

  1. Topical - ofl/cipro/E ointment init 2hrly later 5/day.
  2. Eye irrigation
  3. Top atropine
  4. T/t partner
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18
Q

MCC of chronic conjunctivitis

Symptoms

A

Staph aureus
Other - proteus,E coli,Klebsiella

  1. Redness
  2. Mucoid discharge @ canthi
  3. Burning sensation
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19
Q

Causes of Acute membranous conjunctivitis

A

Unimmunised child = C.diphtheriae

MCC in adults = Pneumococcus

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20
Q

MCC of Angular conjunctivitis

Other name?

A

Moraxella lacunata (or) Axenfield bacillus

Diplobacillary conjunctivitis

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21
Q

Symptoms of angular conjunctivitis

Signs “ “

A
  1. Redness @ angles
  2. Foamy white discharge @ angles
  3. Irritation
  4. Excoriation of skin @ canthi
  5. Hyperemia of bulbar C @ canthi
  6. Freq assoc with Blepharitis
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22
Q

Treatment for Angular conjunctivitis

A
  1. Tetracycline 1% ointment for 2 weeks

2. Zinc lotion @ day nd ointment @ night

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23
Q

Which Conjunctival diseases are caused by which serovars of Chlamydia?

A
  1. Trachoma by A,B,Ba,C
  2. Ophthalmia neonatorum by D-K
  3. Adult inclusion conjunctivitis by D-K serovars

***MCC of preventable blindness.

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24
Q

Which letter is important in Trachoma?

Study These Flashcards
A

F

Transmission- finger,fly,fomite

Follicular nd Mucopurulent

FISTO-who classification

saFe stately for prevention

25
What are the inclusion bodies associated with Chlamydia trachomatis?
HP bodies-Halberstaeder Prowazek
26
What HSN reaction is associated with trachoma?
Type IV reaction Active inflammation nd cicatrisation present together***
27
What are the signs of active trachoma?
Conjunctival 1. Congestion of tarsal nd forniceal C 2. Sago grain follicles with LEBER cells 3. Papillary hyperplasia Corneal 1. Superf K 2. Herbert follicles @ limbus 3. Progressive pannus 4. Corneal ulcer at edge
28
Difference between Trachoma and other types of follicular conjunctivitis?
Presence of leber cells in sago grain follicles and signs of necrosis 1.Adenoviral follicular conjunctivitis-Lower conjunctiva involved nd No pannus nd papillae 2.Palpebral spring catarrh-cobblestone papilla nd ropy discharge
29
What are the signs of cicatricial trachoma?
Conjunctival-scarring,concretions,xerosis,symblepharon -ARLTs line @ palp c btw up1/3 nd lower2/3 Corneal 1.Herbert pits 2.Regressing pannus 3.Corneal opacity Lids-Trichiasis,entropion Lacrimal apparatus- chronic DC
30
What are the 2 classifications of trachoma?
``` McCallan I- stage of infiltration II-stage of florid infiltration III-stage of scarring/cicatrisation IV-stage of healing(sequelae) ``` ``` WHO classification TF-follicular TI-intense inflammation TS-scarring TT-trichiasis TO-opacity ```
31
Only complication of Trachoma?
Corneal ulcer d/t trichiasis
32
Treatment for active Trachoma?(TF and TI)
Topical T/E 1% ointment 2/day for 6 weeks + Systemic Azithromycin 1g oral single dose ***In pregnancy-azithr is C/I....so use T/E 250mg qid for 3-4 weeks Or doxy 100mg bid
33
SAFE strategy and what prevention?
Surgery for trichiasis and entropion(3^ prevention) Antibiotics->10% prev =mass therapy (2^) 5-10% prev =Family nd close contacts <5%=only pt Facial hygiene (1^) Environment changes(primordial prevention)
34
What is ophthalmia neonatorum?
B/L conjunctivitis in infant < less than 30 days old
35
Is there a follicular response in ophthalmia neonatorum ?
Noooo 1. Pain 2. Discharge 3. Swollen lids 4. Conj symptoms
36
Causes of ophthalmia neonatorum and differentiation based on time?
1. Within 6 hrs.........Chemical-AgNO3 2. 24-48hrs......Gonococcal 3. 2-5 days......other bact 4. 5-7 days.......HSV type 2 5. >1week........Chlamydia trachomatis D-K(MCC*)
37
Treatment of neonatal inclusion conjunctivitis?
Topical 1%T (or) 0.5%E for 3weeks
38
Treatment for gonococcal ophthalmia neonatorum?
1.Topical-saline lavage + penicillin 10’-20’IU every 1min,5min...hrly 2.Systemic-Cetriaxone (or)cipro (or)Benzyl Pn IM 50k for full term 20k IU for premature
39
Types of viral conjunctivitis?
1. Adenoviral Keratoconjunctivitis **MC 2. Acute hemorrhagic/Apollo KC 3. Molluscum contagiosum
40
Serovars in Adenoviral KC?
1. EKC- serovars 8,19,37 | 2. PCF-serovars 3,4,7
41
Causes of acute hemorrhagic KC?
1. Picorna family-EV type 70 , coxsackie A24 | 2. Adenovirus serotype 11
42
Preauricular lymphadenopathy is seen in which type of conjunctivitis?
1. Adenoviral 2. Gonococcal 3. Chlamydial
43
Describe the lesion of molluscum contagiosum
U/L,painless nodule with UMBLICATED app
44
Types of allergic conjunctivitis and associated HSN reaction?
1. Simple allergic - type I 2. Vernal KC aka spring catarrh - type I 3. Atopic KC - with atopic dermatitis 4. Giant papillary KC - type IV 5. Phlyctenular KC - type IV
45
Etiology and pathology of VKC?
Etio - B/L,recurrent,MC in young boys.....aka warm weather KC Path - Multiple papillae in upper tarsal conjunctiva
46
Symptoms of VKC?
1. Intense itching 2. Vigorous rubbing 3. Ropy/stringy discharge 4. Redness and Burning sensation
47
Signs of VKC?
Palpebral - Cobblestone (or) pavement stone app of upper tarsal Bulbar - HORNER TRANTA’s spots @ limbus Corneal 1. Punctate epithelial keratitis 2. Shield ulcer 3. Pseudogerontoxon with Cupid bow outline
48
DOC for VKC?
Olopatadine/Alcaftadine(dual action of mast cell stab nd Anti H) Other - Top anti inflam, Top lubric nd mucolytics, systemic, t/t large papillae T/t VK
49
What is the sign for discharge coagulated btw papillae of VKC?
Maxwell-Lyon sign
50
Signs seen in Atopic KC?
DENNIE MORGAN sign - Extra lid folds HERTOGHE sign - Loss of lateral eyebrows
51
Size of papilla in Giant papillary C? | And cause of GPC?
More than 1 mm Mechanically induced by 1. Contact lens 2. Ocular prosthesis 3. Protruding sutures
52
Differences between VKC and Phlyctenular KC?
VKC Phlyctenular KC 1. Type I HSN Type IV HSN 2. Exogenous Ags Endogenous Ags 3. Bilateral Unilateral
53
HSN to which endogenous proteins is seen in Phlyctenular KV?
1. Staphylococcal *(MC) 2. Tubercular 3. Other - moraxella
54
Clinical signs seen in Phlyctenular KC?
Phlycten which may ulcerate 1. Scrofulous ulcer 2. Fascicular ulcer 3. Miliary ulcer
55
What is pinguecula? What is pterygium?
Elastotic degeneration of collagen fibers.....precursor Pterygium is Wing shaped, fibrovascular growth of degenerative and hyperplastic conjunctival tissue over cornea within interpalpebral fissure. Bowman’s membrane and superficial stroma Mostly nasal
56
Risk factors for pterygium?
1. Sunlight - UV B rays 2. Dry, hot climate 3. Smoking 4. Hpv infection *All lead to LSC deficiency.
58
Progressive and regressive pterygium?
Progressive - thick,fleshy,vasc with white spots in front of head known as FUCH spots (or) ISLETS OF VOGT (or) CAP. Regressive - thin,atrophic,less vasc,no cap but deposition of Fe anterior to head known as STOCKER’s line.
59
Symptoms and signs of pterygium?
Symptoms 1. Cosmetic intolerance 2. FBS 3. Defective vision 4. Diplopia** Signs 1.Triangular fold of conj 2.STOCKER’s line 3.Loss of vision d/t astigmatism Or Encroach over visual axis
60
Treatment for pterygium?
Surgical excision with free conjunctival limbal autograft(CLAU) Or Surgical excision with amniotic membrane and topical mitomycin c to prevent recurrences.

Ophtha (4 decks)

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