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conjunctiva Flashcards

1
Q

what is the conjunctiva

A

translucent mucous membrane that covers the anterior globe and terminates at the corneoscleral limbus. The conjunctiva is continuous with the skin at the eyelid margin

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2
Q

parts of the conjuctiva

A
  1. Palpebral conjunctiva: Starts at the mucocutaneous transitional zone of the lid margin and is strongly adherent to the posterior aspect of the tarsal plates.
  2. Forniceal conjunctiva: A loose fold made by the conjunctiva, covering the posterior eyelid and anterior surface of the eyeball.
  3. Bulbar conjunctiva: The thinnest part, covering the anterior surface of the sclera. It is loosely attached, except at the limbus where it is fused with underlying sclera and Tenon’s capsule.
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3
Q

mainly nerve supply to conjunctiva

A

mainly CNV1

inferior conjunctiva - infraorbital nerve

limbus - long ciliary nerve, branch of the nasociliary nerve

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4
Q

blood supply to the conjunctiva

A

palpebral and forniceal - supplied by the peripheral and marginal arterial arcades

bulbar - posterior and anterior conjunctival arteries

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5
Q

lymphatic drainage of the conjunctiva

A

medial - submandibular lymph nodes

lateral part - preauricular lymph nodes.

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6
Q

pathogens for bacterial conjunctivitis

A

streptococcus pneumoniae
- Staphylococcus aureus, - Haemophilus influenzae

  • rarely, Neisseria gonorrhoeae.
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7
Q

features

of bacterial conjunctivitis

ASS w

A

● Unilateral to bilateral.
● Redness, grittiness and purulent discharge.
● ‘sticky eye’ upon awakening.
● Hyperaemia (conjunctival injection).

● Gonococcal disease is typically more severe and hyperacute.
Associated with
lid oedema, severe mucopurulent discharge and lymphadenopathy. (Note: Lymphadenopathy is not present in typical bacterial conjunctivitis.)

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8
Q

Mx for conjunctivitis bacterial

A

self-limiting.

If severe, treat with topical chloramphenicol or fusidic acid.

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9
Q

chlamydial conjucntivits what is it

A

serological variants D–K of Chlamydia trachomatis.

It causes a subacute onset of unilateral conjunctivitis; if left untreated, it may follow a chronic course.

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10
Q

Ix of chlamydia conjunctivitis

A

● Giemsa stain: Basophilic intracytoplasmic inclusion bodies.
● Direct immunofluorescent staining: Free elementary bodies.
● Swab for culturing (McCoy).

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11
Q

features

signs

of chlamydia conjunctivitis

A

● Red eye with mucopurulent discharge.
● Preauricular lymphadenopathy.

● Follicles (whitish, round and discrete swellings) are present, most commonly in the inferior fornix.
● Epithelial keratitis and subepithelial corneal infiltrates may occur.
● Reiter syndrome: Urethritis + arthritis + conjunctivitis/anterior uveitis.

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12
Q

Mx for chlamydial conjunctivitis

A

1 g oral azithromycin single dose

OR
100 mg doxycycline twice a day for 14 days.

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13
Q

what is trachoma

A

leading cause of infectious blindness worldwide

serological variants A–C of C. trachomatis.
Carried by fly vector or direct eye/nasal discharge

type 4 hypersensitivity reaction

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14
Q

trasmission of trachoma

A

musca sorbens fly act as a vector

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15
Q

RFs of trachoma

A
  • poverty and poor hygiene
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16
Q

pathophysiology of trachoma

A

A type IV hypersensitivity reaction. Trachomatous disease is split into two parts: an active inflammatory phase and a cicatricial (scarring) chronic phase.

active inflammation

scarring

trichiasis

blindness due to the corneal damage due to eyelashes irritating the cornea

nnocuous + heightened inflammatory response upon reinfection

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17
Q

epidemiology of trachoma

A

● The most trachoma-endemic continent is Africa.
● The highest prevalence is in Ethiopia.
● Number of global visually impaired or blind: 1.9 million people.
● Women are four times more likely to require surgery for trichiasis.

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18
Q

WHO staging of trachoma

A
  1. Trachomatous inflammation-follicular (TF): 5+ follicles present in the upper tarsal conjunctiva.
  2. Trachomatous inflammation-intense (TI): Upper tarsal conjunctiva is thickened, and the majority of the blood vessels are obscured.
  3. Trachomatous scarring (TS): Conjunctival scarring (cicatricial).
  4. Trachomatous trichiasis (TT): Ingrowth of eyelashes towards the cornea.
  5. Corneal opacity (CO): Due to eyelashes rubbing on the cornea.
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19
Q

what is the active inflammatory phase of trachoma

A

● Follicular conjunctivitis: Most prominent in the superior tarsal plate. May be associated with papillae (red, elevated dots with a vascularized centre).

● Vascularization of the superior cornea (pannus formation).

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20
Q

what is the chronic cicatricial phase

A

● Herbert pits: Shallow depressions in the superior limbus created by follicles (pathognomonic for trachoma).
● Arlt’s line: Conjunctival scars.
● Trichiasis, entropion and eventual corneal opacities may eventually develop.

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21
Q

Mx for trachoma

A

WHO ‘SAFE’ strategy (2):

● Surgery for trichiasis: Bilamellar tarsal rotation surgery can be performed to correct trichiasis.
● Antibiotics: Single dose of 1 g oral azithromycin.
● Facial cleanliness.
● Environmental improvement.

Tx: Azithromycin, Erythromycin, Doxycyline. WHO – “SAFE”

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22
Q

what is opthalmia neonatorium

A

Ophthalmia neonatorum is defined as conjunctival inflammation developing in the first 30 days of life

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23
Q

causes of opthalmia neonatrum

A

chlamydia
gonococcal
HSV
Staphylococci

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24
Q

features

onset

Mx of chlamydia conjunctivitis

A

Mucopurulent discharge and papillary conjunctivitis

1-3 weeks

oral erythromycin

25
Q

features

onset

Mx of gonococcal opthalmia neonatrum

A

Hyperpurulent discharge, eyelid swelling ± corneal ulcer

1-3 days

IM ceftriaxone

26
Q

features

onset

Mx of HSV

A

Watery discharge, periocular skin vesicles and dendritic corneal epithelial lesion

1-2 weeks

IV acyclovir

27
Q

features

onset

Mx of staphylococci

A

purulent discharge and mild sticky eye

1 week

topical chloramphenicol

28
Q

most common causativr agent in viral conjunctivitis

A

adenovirus

Herpes simplex

Molluscum contagiosum

29
Q

features of acute nonspecific follicular conjunctivitis

type of viral conjunctivitis

A
  • red, itchy, gritty eye w ass watery discharge
  • starts unilateral but progresses to bilateral involvement after a couple of days
  • follicular conjunctivitis withi conjunctival hyperaemia
  • periauricular lymphadenopathy
30
Q

features of pharyngoconjunctival fever

A

due to adenoviral serotypes 3,4 and 7

  • fever
  • pharyngitis
  • conjunctivitis
  • lymphadenopathy
  • keratitis
31
Q

epidemic keratoconjunctivitis

which type of virus

signs seen

A

due to adenoviral serotypes 8, 19 and 37

  • conjunctivitis
  • keratitis:
  • – occurs after conjunctivitis
  • – characterised by epithelial microcysts (early) and punctate epithelial keratitis (late)
  • – more common in EKC than in PCF
32
Q

subtypes of allergic conjunctivitis

A
  1. Seasonal and perennial allergic conjunctivitis
  2. Vernal keratoconjunctivitis (VKC)
  3. Atopic keratoconjunctivitis (AKC)
  4. Giant papillary conjunctivitis
33
Q

types of seasonal and perennial allergic conjunctivitis

A
  1. Seasonal: IgE-mediated type I hypersensitivity. Worse during spring and summer.
  2. Perennial: IgE-mediated type I hypersensitivity. All year round when exposed to allergens.
34
Q

features of seasonal and perennial allergic conjunctivitis

A

● Red, watery and itchy eye.
● May be associated with rhinitis.
● Conjunctival hyperaemia and papillary conjunctivitis.

35
Q

Mx of seasonal and perrineal allergic conjunctivitis

A

● Avoid allergens
● Artificial tears
● Topical/oral antihistamines
● Topical sodium cromoglicate

36
Q

what is Vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC)

A

Both VKC and AKC affect conjunctiva, eyelids and the cornea
They are both bilateral conditions, expressing IgE-mediated (type I hypersensitivity) and T-cell-mediated (type IV hypersensitivity) immune responses.

37
Q

symptoms of VKC and AKC

A

itching, discharge, blepharospasm and photophobia.

38
Q

Mx of VKC and AKC

A 
● Avoid allergens
● Artificial tears
● Topical/oral antihistamines
● Topical cromoglicate
● Topical ciclosporin
● Topical steroids
39
Q

wjat is giant papillary conjunctivitis

A

A type I and IV hypersensitivity reaction to contact lens wear. Patients usually complain of increased ocular tiredness while wearing contact lenses.

  • ass w pruritus
  • red eye
    mucous secretion

worse after taking off the lenses

40
Q

signs of giant papillary conjunctivitis

A

● Superior tarsal hyperaemia.
● Superior tarsal papillae (classically ‘giant’ >1 mm; however, size is not
necessary for diagnosis).

41
Q

what is ocualr mucous membrane pemphigoid

patho

common in who

A

This is a chronic, blistering autoimmune disease. It has a type II hypersensitivity response to autoantibodies attacking the basement membrane. Typically, elderly females are affected.

42
Q

features of ocular mucous membrane pemphigoid

A

● Bilateral conjunctivitis with conjunctival hyperaemia, swelling and subepithelial fibrosis (mostly seen in inferior fornix), associated with reduced inferior forniceal depth.
● Symblepharon: Union of the palpebral and bulbar conjunctiva.
● Dry eyes due to goblet cell destruction.
● Trichiasis.
● Chronic blepharitis.
● Ankyloblepharon: Union of lateral canthus and both eyelids.
● Keratinization, vascularization and epithelial defects of the cornea may
ensue.

43
Q

Ix of ocular mucous membrane pemphigoid

A

Direct conjunctival immunofluorescence: linear bands of IgG and IgA deposits at the basement membrane.

44
Q

Mx for ocular mucous membrane pemphigoid

A

Dapsone can be used for mild disease. Other immunomodulatory agents (e.g. azathioprine and methotrexate) can be used for more severe cases. Corticosteroids are useful for severe acute cases.

45
Q

define Superior limbic keratoconjunctivitis (SLK)

A

idiopathic chronic inflammatory condition affecting the superior bulbar conjunctiva, limbus and cornea.

46
Q

SLK ass with

A

females and there appears to be a strong association with TED. There is also an association with sicca syndrome and rheumatoid arthritis.

47
Q

features of SLK

A

Gradual-onset foreign body, burning and itching with associated photophobia and pain. On examination, there is:
● Localized conjunctival hyperaemia and papillary reaction superiorly.
● Occasionally, thickening of the superior bulbar conjunctiva is seen. This
stains with fluorescein and rose bengal stains.
● Cornea may be affected with superior punctate epithelial erosions and
filamentary keratitis.

48
Q

What is parinaud oculoglandular syndrome

A

various bacterial, fungal and viral agents, most notably Bartonella henselae (cat scratch disease).

  • granulomatous unilateral conjunctivitis - with ipsilateral preauricular lymphadenopathy associated with a
  • low-grade fever.
49
Q

what is pinguecula

A

Bulbar conjunctival degeneration characterized
- yellow/white patch most commonly on the nasal limbus.

It never grows over the cornea. Risk factors include ultraviolet light exposure and ageing.

50
Q

what is pterygium

A

Bulbar conjunctival degeneration characterized by a pink fleshy triangular- shaped fibrovascular wedge (Figure 9.1). Usually arises on the nasal limbus, causing destruction of Bowman’s layer, and grows over the cornea.

51
Q

complications of pterygium

A

obscuring the optical access and causing astigmatism. Risk factors are ultraviolet light and dry climates.

52
Q

features of pterygium

A

● Stocker’s line: Epithelial iron deposits in the cornea.
● Fuchs’ islets: Small white dots in the cornea.
● May cause ocular dryness, astigmatism or reduced vision (if within visual axis).

53
Q

Mx of pterygium

A

Conservative management (reassurance, lubrication) or surgical excision for cosmesis or for visual interference. However, it should be noted that recurrence is high.

54
Q

Sx of endophthalmitis

A 
redness
pain
bliurred vision
floaters
photosensitivity
hypopyon
corneal haze
55
Q

RFs of vernal conjunctivitis

A

Atopic; African / Asian descent

  • Affects superior palpebral conjunctiva
  • Giant papillae
  • Horner-trantas dots
56
Q

vernal v atopic keratoconjunctiivtis

A

look at lecture

57
Q

causes of pseudopterygium and its difference

A

Acute inflammatory episode:

  • Chemical burn
  • Corneal ulcer - Trauma
  • Cicatrizing conjunctivitis

only attached at apex

58
Q

causes of pingecula to pterygium

A

Chronic UV exposure Chronic surface dryness Hot climates

DEP (20 decks)

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