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the conjuctiva and sclera Flashcards

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1
Q

what are the three anatomical parts of the conjunctiva ?

A

the palpebral conjuctiva
the forniceal conjuctiva
the bulbar conjuctiva

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2
Q

what are the components of the conjunctiva ?

A

non keratinizing stratified squamous cell epithelium
goblet cells
substantia propria

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3
Q

what is the junction between the conjunctiva and the sclera called ?

A

the cornoscleral limbus

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4
Q

what are the different types of conjunctival reactions ?

A

hyperemia - conjunctival injection
chemosis - conjunctival oedema
subconjuctival hemorrhage
follicles
papillae

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5
Q

what are the features of conjuctival injection ?

A

hyperemia that extends away from the limbus

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6
Q

what are the causes of chemosis ?

A

acute: allergic reactions
chronic : thyroid eye disease, right sided heart failure and nephrotic syndrome

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7
Q

what are the causes of subconjuctival haemorrhage ?

A

viral conjunctivitis
valsalva or trauma
hypertension and diabetes
idiopathic
bleeding disorders

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8
Q

what are the causes of membrane formatiion ?

A

adenovirus
steven johnson syndrome
gonococcal conjuctivitis

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9
Q

how can you differentiate between a pseudomembrane and a true membrane ?

A

pseudomembrane can be peeled leaving behind an intact epithelium
A true membrane if peeled will leave behind a torn epithelium

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10
Q

what are follicles ?

A

multiple, discrete and translucent slightly elevated lesions that resemble translucent grains of rice, most prominent in the fornices

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11
Q

what are the causes of follicles ?

A

viral or chlamydiayal conjuctivitis
hypersensitivity to topical medications

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12
Q

what are papillae ?

A

can develop only in the palpebral conjunctiva and limbal bulbar conjunctiva

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13
Q

what are the causes of papillae ?

A

bacterial or allergic components
contact lens wearers
floppy eye syndrome

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14
Q

what are the classifications of conjunctivitis ?

A

infective
allergic
iatrogenic

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15
Q

what are the causes of bacterial conjunctivitis ?

A

strep pneumoniae
h influenza

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16
Q

what are the symptoms of bacterial conjunctivitis ?

A

redness
foreign body sensation
discharge which is usually bilateral but one eye may precede the other ( mucopurulent discharge)
vision is usually normal

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17
Q

what must be done in cases of suspected meningococcal or gonococcal infection ?

A

conjunctival swab

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18
Q

what must be done in cases of chlamydia or viral infections ?

A

PCR

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19
Q

what is the treatment for bacterial conjunctivitis if thee causative organism is not h.influenza , or gonococcal infection ?

A

topical antibiotics 4 times a day
either chloramphenicol, aminoglycosides, quinolone or macrolides

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20
Q

what is thee treatment for bacterial conjunctivitis caused by
h.influenza
gonococcal infection
meniingococcal infection ?

A

h.influenza :amoxicillin / clavulanic acid
gonococcal : 3rd generation cephalosporins
meningococcal : benzyl penicillin , ceftriaxone or ceftraxime IM can be used

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21
Q

what type of transmission or type of infection is adult chlamydial conjunctivitis ?

A

occulogenital infection
transmission is auto inoculation from genital secretions

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22
Q

what are the serological variants associated with adult chlamydia infection ?

A

D-K

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23
Q

what is the incubatioin period for adult chlamydia infection ?

A

app one week

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24
Q

what is the most common causee of non gonococcal urethritis in males ?

A

chlamydia

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25
what are the symptoms associated with adult chlamydial infection ?
subacute unilateral or bilateral redness watering and or discharge
26
what are the signs associated with adult chlamydial infection ?
watery or mucopurulent discharge tender pre auricular lymphadenopathy large follicles most prominent in the inferior fornix superficial punctate keratitis is common superior corneal pannus mild conjuctival scarring
27
what are the investigations for a case of suspected adult chlamydia conjunctivitis ?
tarsal conjuctival scraping for geimsa stain
28
what would a positive giemsa stain for adult chlamydial conjunctivitis show ?
basophilic inclusion bodies in epithelial cells lymphocytes in newborns
29
what is the treatment for adult chlamydial infection ?
referral to a genitourinary specialist systemic ab- azithromycin 1g repeated after 1 week is the treatment of choice , topical antibiotics are not enough reduce risk of transmission - no sexual activity until treatment is over re-test in 6-12 weeks
30
what are the alternatives to azithromycin in ACC ?
erythromycin amoxicillin ciprofloxacin
31
what are the associated factors with trachoma ?
overcrowding poor hygiene flies are an important factor
32
what type of response is associated with a trachoma infection ?
delayed hypersensitivity type 4
33
what is the causative organism in Trachoma ?
also chlamydia but strains A to C
34
what are the stages of trachoma divided into ?
active stage ( acute) cicatricial stage ( chronic )
35
what are thee features associated with the active form and stage of trachoma ?
common in pre school children presents with both papillae and follicles associated with mucopurulent discharge in children under the age of 2 - papillary + pannus formation
36
what is pannus ?
vascular invasion that occurs on the periphery of the cornea
37
what are the features of cicatricial trachoma ?
common in middle aged patients linear conjunctival scars called Arlts line superior limbal follicles - Herbert pit trichiasis cicatrization - formation of scar tissue cicatricial entropion - eyelids turn toward the globe due to fibrosis corneal opacification dry eyes due to destruction of goblet cells
38
what is the grading system for trachoma ?
TF - A few follicles in the superior tarsal plate TI - follicles and papillae TS - corneal scaring and Arlts lines TT - Trichiasis CO - reached corneal opacity
39
what is the management for trachoma ?
SAFE Surgery to relieve entropion and trichiasis for complete lid closure Antibiotics for thosee affected and family members - azithromycin Facial cleanliness Environmental improvement
40
what is the most frequent causative agent for viral conjunctiivitis ?
adenovirus
41
how is adenoviral conjunctivitis transmitted ?
transmission generally by contact with respiratory or ocular secretions
42
what is the most common clinical form of viral conjunctivitis ?
non-specific acute follicular conjunctivitis which is usually due to adenovirus
43
history of URTI and then presents with viral conjunctivitis ?
pharyngoconjunctival fever
44
most severe adenoviral conjunctivitis ?
epidemic keratoconjunctivitis
45
what is the causative organism in acute haemorrhagic conjunctivitis ?
tropical areas enterovirus coxsackievirus
46
what are the signs of viral conjunctiivitis ?
watery eye discharge eyelid oedema lymphadenopathy conjunctival hyperemia conjunctival follicles
47
what sign is specific to adenoviral conjunctivitis ?
keratitis
48
what signs are seen in molluscum contagiosum ?
pale waxy nodule on the lid of the margin follicular conjunctivitis
49
what is the treatment for viral conjunctivitisi ?
adenoviral is self limiting within 2-3 weeks reduce transmission risk , hawi 3al 3ayan discontinuation of CL
50
what are the types of allergic conjunctivitis ?
acute allergic conjunctivitis seasonal allergic conjunctivitis perennial allergic conjunctivitis
51
what is the hallmark of allergic conjunctivitis ?
chemosis
52
what are the seasonal associations with allergic conjunctivitis ?
acute allergic - spring and summer seasonal allergic - hay feever eyes - spring and summer - pollen perinneal allergic conjunctivitis - autumn - but less severe - pets in the house
53
what is the immune response associated with vernal keeratoconjunctivitis ?
IgE and cell mediated immunity
54
what is the treatment for allergic conjunctivitis ?
avoidance of allergen first if mildd - artificial tears moderate - mast cell stabilizers or antihistamine severe - topical steroids
55
what are the classifications of VKC ?
palpebral VKC - upper tarsal conjunctiva with papillae LImbal VKC - limbal conjunctival papillae Mixed VKC
56
what age group is associated with AKC ?
30-50 yr olds unlike VKCC 5 year old boys
57
what are thee seasonal association with AKC vs VKC ?
VKC is seasonal and is worse in thee spring AKC is perineeal and worse in the winter
58
what other diseases are associatedd with AKC ?
history of atopic dermatitis asthma
59
what are the sympttoms of AKC and VKC ?
eyelid erythema and scaling conjunctival discharge hyperemia and papillae cicatrization which may lead to symblepharon corneal keratopathy , keratoconus
60
what complications are more likely to happen to AKC and VKC patients ?
retinal detachement presenile subcapsular cataract
61
what are the general measures for VKC and AKC ?
ABC approach Avoid allergen Bandage contact lens Cool compresses
62
what is the medical management for VKC and AKC ?
mast cell stabilizers topical antihistaminic Topical NSAIDS topical steroids oral histamines
63
what is the management for unresponsive cases of AKC and VKC ?
ciclosporin tacrolimus ointment
64
what surgeries can be performed for AKC and VKC ?
superficial keratectomy surface restoration surgeries
65
what iss the etiology of giant papillary conjunctivitis ?
mechanically induced papillary conjunctivitis
66
what are thee causes of giant papillary conjunctivitis ?
contact lens wear exposed sutures and scleral buckles ocular prosthesis
67
what are the symptoms of giant papillary conjunctivitis ?
foreign body sensation itching redness increased mucus production blurring and loss of CL tolerance **symptoms may worsen after lens removal**
68
what are the signs associated with giant papillary conjunctivitis ?
CL protein deposits may be present mucous discharge superior tarsal hyperemia ptosis and tissue laxity may occur due to chronic irritation variable size papillae up to giant
69
what is the treatment for Giant papillary conjunctivitis ?
removal of the stimulus ensure effective cleaning of CL topical drops as antihistamines , NSAID, mast cell stabilizers
70
what is pinguecula ?
asymptomatic elastotoic degeneration of the stroma yellow mound found on the bulbar conjunctiva found more on the nasal limbus rather than the temporal limbus doesn't grow over the cornea
71
what is the treatment for pinguecula ?
no treatment required
72
what is pterygium ?
triangular fibrovascular subepithelial growth point of the triangle points towards the cornea grows over the cornea
73
what are the differential diagnosis of pterygium ?
pseudo-pterygium
74
what are the parts of a pterygium ?
cap head body
75
how can you tell the difference between episcleritis and scleritis ?
episcleritis - painless, foreign body sensation , vessels blanch with 10% phenylpherine drops self limiting but recurring scleritis - very painful , exaceerbbated by eye movements andd can wake the patient up from their sleep conjuctival vessels do not blanch on 10% phenylpherine
76
what is the management of episcleritis vs scleritis ?
episcleritis - avoid steroid drops, oral NSAIDs scleritis - investigate for a systemic disease, oral NSAIDs

opthalmology (14 decks)

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