Exam 2 Lecture 1 - Conjunctiva Flashcards Preview

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1

transparent mucous membrane lining inner surface of eye lids and globe surface up to limbus, firmly attached to tarsal plates, plica semilunaris has caruncle that has cutaneous tissue containing hair follicles, sweat glands, and oil glands, epiethelium, adenoid, fibrous layer. 5 layers.

Conjunctiva

2

Arteries supplying blood to conjunctiva

Anterior ciliary and palpebral arteries

3

Tissue consisting of lymphocytes within epiethelial and stromal layers, associated blood vessels, and follicular aggregates. Critical for the initiation and regulation of ocular surface immune responses

Conjunctiva-Assocaited Lymphoid Tissue

4

secretion associated with white color, chronic allergic conjunctivits and dry eye

Mucoid secretion

5

secretion with serous exudate and tears, seen in allergic and viral conditions

Water secretion

6

Diffuse meaty red conjunctiva can indicate what

bacterial conjunctivitis

7

Purple red conjunctiva can indicate what

Viral conjunctivitis

8

Pinky- red conjunctiva can indicate what

Allergic Conjunctivitis

9

sign in conj of viral conj or sometimes bacterial conj such as H influenza, N meningiditis, S Pneumoniae, Enterovirus and cozsackievirus, can be subconjunctival in cases like valsalva maneuver, trauma, high BP, blood thinners like coumadin, warfarin, heparin, aspirin

Hemmorhages

10

Translucent swelling of conjunctiva - exudation from permeable capillaries - rubbing eyes excessively in allergic conj, chronic can mean orbital outflow constriction

Chemosis

11

Coagulated exudate adherent to inflamed tarsal conjuctival epithelium, PEELED EASILY, gonococcal conj, steven-johnson, severe adenoviral infection

Pseudomembrane

12

Inflammed exudate permeates the superficial layer of conj epithelium, tear with removal and cause bleeding- beta hemolytic infections and diphtheria

True Membrane

13

Cellular recruitment to the site of chronic inflammation and typically accompanies papillary response, recognized by loss of detail of the tarsal vessels, look whiteish - myeloid sarcoma for example

Infiltration

14

cicatricial entropion causing loss of goblet cells and accessory lacrimal glands can be a result of what?

Subconjunctival scarring - chalazion removal leaves scar on inner side of eyelid

15

Multiple discrete slightly elevated lesions, looks like translucent grains of rice or soldiers in a row - VIRAL CONJUNTIVITIS, more prominent at fornices. Blood veseels are AROUND not within. use red free filter to view better. Sub - epithelial lymphoid germinal centers with central immature lymphocytes and mature cells, clusters of lymphocytes. Caused by VIRAL and chlamydial conjunctivitis - Parinaud oculoglandular syndrome, hypersensitivity. Normal finding in children

FOLLICLES - LYMPHOCYTES/VIRUS

16

Elevated lesions in tarsal conjunctiva and limbal conjunctiva with vessels going THROUGH not around. TRANTA DOTS when in limbus area. Folds of hyperplasctic con with fibrovascular core and subepithelial stromal infiltration with inflammatory changes. Late changes - superficial stromal hyalinization, scarring, crypts. Caused by alergic/bac/ conj. CL wear, SLK, floppy eyelid syndrome

PAPILLAE- ALLERGIES/FOREIGN BODIES

17

Way to detect viral infection, occurs in chlamydial and severe bacterial conjunctivitis, such as gonoccocal and parinaud oculoglandular syndrome.

Lymphadenopathy

18

Conjunctivitis classifications
1. al of a sudden
2. onset within 12 hours
3. between acute and chronic
4. Longer than 4 weeks

1. Acute - SPK, red eye, sticky eyelids
2. Hyperacute - gonococcal - severe mucopurulent discharge
3. Subacute -
4. Chronic - follicular reaction - chlamydial disease, drug toxicity

19

general Type of conjunctivitis usually bacterial or HSV - viral, allergic - vernal/atopic, pediculosis

Acute Onset Conjunctivitis

20

general type of conjunctivitis with chlamydial inclusion, trachoma, molluscum contagiosum, toxicity, parinauds, neonatal

Chronic conjunctivitis

21

Common and self limiting conjunctivitis with infected secretions, not usually severe unless N gonorrhea which can invade the cornea. Meningitis can cause it but is rare and typically in children. Meaty red conj, may spread to other eye, matted shut eyelids when waking up

Acute BACTERIAL conjunctivitis

22

DIscharge due to gonococcal or meningococcal conjunctivitis

Hyperacute Purulent discharge

23

What can occur in the cornea as a result of gonococcal or meningococcal conj - acute bacterial conj.

Peripheral corneal ulcer

24

Acute bacterial conj is - PAN unless what

gonococcal or meningococcal- swabs and scrapings for gram staining to rule out gram negative diplococci - kidney shaped

25

PCR is done to rule out what etiology for acute bacterial conjunctivitis

chlamydia or viral infection

26

Chocolate Agar and thayer martin are used to rule out what etiology

N. Gonorrhea

27

2 common gram positive and 3 common gram negative causes of Acute bacterial conj. which can lead to corneal ulcers in compromised patients and is common in alcoholics?

1. Staph and strep - strep can have petechias or pseudomembranes
2. Haemophylus aegyptus, influenzae - URI or ear infection common, resembles preseptal cellulitis and can lead to meningitis
Morax-Axenfeld- common in alcoholics, lead to ulcer. Chlamydia trichomatis - needs Oral AB

28

How to treat acute blepharitis caused by gram negative chlamydia

no topicals - ORAL azithromycin or doxy, erythro, tetra

29

Treatment for Acute Bacterial conjunctivitis by bacteria

Polytrim or tobradex, EEM or Bacitracin, Ciprofloxacin.

30

Are most acute conj cases bacterial or viral?

VIRAL