CONJUNCTIVAL VARIATIONS

Question 1

FOLLICLES

• Histopathology: focal hyperplasia, newly formed lymph tissue
• Size: small – 0.5mm to 2mm
• Location: commonly found on palp conj
• Appearance: elevated, clear to milky centers, base of follicle has BVs
• Pathophysiology: hallmark of localized cell mediated immune response

Answer 1

Causes

• Toxins: irritants that develop hypersensitivities (molluscum
  contagiosum, chemicals)
  
  • Viral conjunctivitis

Folliculosis

• condition, not a disease
• found in younger pop (kids – young adolescents)
• caused by hyperactive lymphatic system
• disappears with age
• eye is otherwise quiet

Question 2

PAPILLAE

• Histopathology: non-specific response to conjunctival
  irritants
• fibrovascular in origin
• Size: small to large?? Lmao
• Location: elevations usually found on upper/lower palp conj
• Appearance: deep red vascular elevation, BV at the core

Answer 2

Causes

• bacterial infections,
• contact lens wear,
• allergies

Giant papillae: occur in vernal
conjunctivitis and GPC

Question 3

XEROSIS

• Rare in US, caused by vitamin A deficiency
• Avascular yellowish, slightly elevated patch on bulbar conj in
  interpalp zone
• Keratinization of conj

Answer 3

Symptoms

• severe dry eye,
• goblet cells not producing enough mucin

Management

• Lubrication with art gtts/ung, advise increase in
  vitamin A intake

Question 4

RETENTION CYSTS

• Clear blisters on bulbar/palepebral conj, typically in
  interpalp zone
• usually due to dry eye or dellular degeneration
• Asymptomatic

Answer 4

Management

• lance, if you pop it, it’ll just refill
• Leave them alone unless
  pt is concerned

Question 5

PINGUECULAE

• Very common in environment with wind/dust/UV exposure, usually in IP zone on bulb conj
• Caused by fibrovascular degeneration
• Can also be from mechanical rubbing from CL’s
• Yellowish white mass, flat but slightly
  elevated

Answer 5

Pingueculitis: dilation of BVs, usually
due to an irritant, self-limiting

• Can give OTC vasoconstrictor (visine) – 1gtts QID max 4-5days
• Can also give regular art tears

• MGMT: pt education, UV protec

Question 6

PTERYGIUM

• Common in warmer climates, associated w/UV exposure, dust
• Made of similar material as pingueculae
• Extends from sclera onto cornea, replaces Bowman”s layer with a fibrovascular layer
• Fleshy triangular growth extending onto cornea, apex points twd pupil
• Symptoms: blurred vision, monocular diplopia (only if on pupil), dry eye, FBS, redness

Answer 6

Complications:

• irregular astigmatism, dry eye, decreased VA

MGMT:

• photo document, measure length from limbus to apex as well as height, record
• Surgical removal: must catch before migration to visual axis due to scarring
• Stocker’s line: iron deposit on edge of pterygium, indicates inactive

• Pinguecula CANNOT become pterygium!

Question 7

CONCRETIONS

• AKA Lithiasis

Answer 7

• Small yellow/white deposits on upper/lower
  palp conj
• ~1-3mm in size
• representative of a degeneration of epithelial
  cells/mucin secretions
• Can also be caused by chronic allergies
• Varying number can be present
• Bigger ones can result in small pebble like
  sensation, can use wet qtip to massage/loosen it up

Question 8

ADENOCHROME DEPOSITS

• Pigment granules on lower fornix/palp conj
• Usually due to epinephrine medciation for glaucoma

Answer 8

• Disappear once epinephrine is disco’d
• Can cause macular edema

Question 9

MELANOMA

• Look for pigmentation that changes in size and
  elevation

Answer 9

• Can arise from nevus or spontaneously form UV
  exposure

Question 10

KAPOSI SARCOMA

• Abnormally vascularized palp conj
• elevated growth causing mechanical ectropion

Answer 10

• common in HIV pts with low t count
  
  • less incidence with retroviral
    drugs
• focal vascularization on palp conj
• Associated: some melanosis, pinguecula