Post on 15-Apr-2016
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CLINICAL SPOTTERS OF CONJUNCTIVA
SEETHAL K.RSEETHAL K.RFELLOW OPTOMETRISTFELLOW OPTOMETRISTTHE EYE FOUNDATIONTHE EYE FOUNDATION
CONJUNCTIVACONJUNCTIVA
► It is the mucous membrane It is the mucous membrane covering the under surface of the covering the under surface of the lids and anterior surface of the lids and anterior surface of the eyeball up to cornea.eyeball up to cornea.
PARTS OF CONJUNCTIVAPARTS OF CONJUNCTIVA► PalpebralPalpebral: Covering the : Covering the
lid - firmily adherent.lid - firmily adherent.► FornicealForniceal:Covering the :Covering the
fornices – loose – fornices – loose – thrown in to folds.thrown in to folds.
► BulbarBulbar:Covering the :Covering the eyeball – loosely eyeball – loosely attached except at attached except at limbus. limbus.
SYMPTOMOLOGYSYMPTOMOLOGYNON SPECIFICNON SPECIFIC► LacrimationLacrimation► IrritationIrritation► StainingStaining► BurningBurning► PhotophobiaPhotophobia► RednessRedness
SPECIFICSPECIFIC► Pain FB sensation in Pain FB sensation in
corneal involvementcorneal involvement► Itching in Itching in
allergic,blephritis allergic,blephritis and dry eyesand dry eyes
CLINICAL SPOTTERSCLINICAL SPOTTERSCONJUNCTIVAL REACTIONSCONJUNCTIVAL REACTIONS
HYPERAEMIA OF THE HYPERAEMIA OF THE CONJUNCTIVACONJUNCTIVA
►Dilatation of the Dilatation of the blood vessels blood vessels without exudation without exudation or cellular or cellular infiltrationinfiltration
HYPERAEMIAHYPERAEMIA
CausesCauses► Irritation by smoke,dust Irritation by smoke,dust
or fumes or fumes ► Exposure to wind and sunExposure to wind and sun► Bath and swimmingBath and swimming
SymptomsSymptoms
► May be presentMay be present► FBsensationFBsensation
SignsSigns
► Only rednessOnly redness
TreatmentTreatment
► e/d containing e/d containing phenylephrine or phenylephrine or naphazolinenaphazoline
CONGESTIONCONGESTION► CONJUNCTIVALCONJUNCTIVAL ► CILLARYCILLARY
CONGESTIONCONGESTIONConjunctival Conjunctival congestioncongestion
Cilliary Cilliary congestioncongestion
APPEARENCEAPPEARENCE Vessel Vessel superficial ;Bsuperficial ;Bright right red ;mostly red ;mostly in the in the foenices foenices
Vessels deep Vessels deep ;violet or ;violet or dusky red ; dusky red ; mostly at the mostly at the limbuslimbus
BLOOD BLOOD VESSELSVESSELS
Fill up from Fill up from the fornixthe fornix
Fill up from Fill up from the limbusthe limbus
DISEASEDISEASE ConjunctivitsConjunctivits Keratitis,iridoKeratitis,iridocyclitis,or cyclitis,or angle closure angle closure glucomaglucoma
CHEMOSISCHEMOSIS► Swelling of the Swelling of the
conjunctivaconjunctiva► Related to allergies Related to allergies
or an eye infectionor an eye infection► Also be a Also be a
complication of eye complication of eye surgery or occur surgery or occur from rubbing the from rubbing the eye too mucheye too much
SUBCONJUNCTIVAL SUBCONJUNCTIVAL HAEMORRHAGEHAEMORRHAGE
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SymptomsSymptoms► Eye will look blood Eye will look blood
hot and feeling of hot and feeling of tightness in the tightness in the effected eyeeffected eye
TreatmentTreatment► Does not require TxDoes not require Tx► Bloodshot apperence Bloodshot apperence
disappear in 2 to 3 disappear in 2 to 3 weeksweeks
EtiologyEtiology ► Coughing,knoking Coughing,knoking
or rubbing of eye or rubbing of eye too muchtoo much
►Diabetes or high Diabetes or high blood pressure blood pressure patients are more patients are more likely to getlikely to get
►Direct trauma to the Direct trauma to the eye balleye ball
FOLLICLEFOLLICLE
►They are round swelling due to They are round swelling due to aggregation of lymphocytes and other aggregation of lymphocytes and other cells at adenoid layercells at adenoid layer
FOLLICLEFOLLICLE
SIGNSSIGNS►Multiple,discrete,slightMultiple,discrete,slight
ly elevated lesionsly elevated lesions
► Encircled by tiny blood Encircled by tiny blood vesselsvessels
► Size can vary from 0.5 Size can vary from 0.5 to 5 mm related to the to 5 mm related to the severity and durationseverity and duration
ETIOLOGYETIOLOGY
► Viral and chlamydial Viral and chlamydial infectioninfection
PAPILLAEPAPILLAESeen inSeen in► Chronic blepharitisChronic blepharitis► Allergic conjunctivitisAllergic conjunctivitis► Bacterial conjunctivitisBacterial conjunctivitis► CL wearerCL wearer► Superior limbic Superior limbic
keratoconjunctivitiskeratoconjunctivitis► Floppy eyelid Floppy eyelid
syndromesyndrome
PAPPILLAEPAPPILLAE►Frequently seen in upper palpebral Frequently seen in upper palpebral
conjunctiva conjunctiva ►fine mosaic like pattern of elevated fine mosaic like pattern of elevated
polygonal hyperaemic areas polygonal hyperaemic areas ►Reddish flat topped raised areas Reddish flat topped raised areas ►Each consist of dilated blood vessels at Each consist of dilated blood vessels at
centre with surrounding lymphocytescentre with surrounding lymphocytes
PSEUDO-MEMBRANEPSEUDO-MEMBRANE
PSEUDOMEMBRANEPSEUDOMEMBRANESIGNSSIGNS►Outside epitheliumOutside epithelium
► Coagulated exudates Coagulated exudates loosely adherent to the loosely adherent to the inflamed conjunctival inflamed conjunctival epitheliumepithelium
► Can be easily peeled off Can be easily peeled off
with out any bleedingwith out any bleeding
FORMS INFORMS IN► Adenoviral infectionAdenoviral infection► Vernal conjunctivitisVernal conjunctivitis► Pneumococcal Pneumococcal
conjunctivitisconjunctivitis►Gonococcal Gonococcal
conjunctivitisconjunctivitis
MEMBRANESMEMBRANES
FORMS INFORMS IN
► Bacterial infectionBacterial infection
MEMBRANESMEMBRANES
AetiologyAetiology►DiphtheriaDiphtheria► Beta-haemolytic Beta-haemolytic
streptococcistreptococci
SIGNSSIGNS► Include epithelium Include epithelium ► Infiltrate the Infiltrate the
superior layer of superior layer of conjunctival conjunctival epitheliumepithelium
► Epithelium is injured Epithelium is injured if removal if removal attemptedattempted
CONJUNCTIVAL CONJUNCTIVAL DEGENARATIONSDEGENARATIONS
CONCRETIONSCONCRETIONS FeaturesFeatures► Minute hard Minute hard
yellow/white spots in yellow/white spots in palpebral conjunctivapalpebral conjunctiva
► Due to accumulation Due to accumulation of degenerated of degenerated epithelial cellsepithelial cells
► Common in Common in elderly ,usually elderly ,usually symptom lesssymptom less
PINGUECULAPINGUECULA► This is a yellowish This is a yellowish
triangular deposit triangular deposit on the conjunctiva on the conjunctiva near the limbusnear the limbus
►Normally symptom Normally symptom less but when less but when inflamed it treated inflamed it treated with topical steroidswith topical steroids
PINGUECULAPINGUECULA
►Found in elderly people who are Found in elderly people who are exposed to strong sunlight,dust and windexposed to strong sunlight,dust and wind
►The apex of the triangle is away from the The apex of the triangle is away from the cornea, and it effects the nasal side first cornea, and it effects the nasal side first then the temporalthen the temporal
►Growth is very slow or absent Growth is very slow or absent
PTERIGIUMPTERIGIUM►Triangular fibro vascular sub epithelial Triangular fibro vascular sub epithelial
in growth of degenerative bulbar in growth of degenerative bulbar conjunctival tissueconjunctival tissue
PTERYGIUMPTERYGIUM►A small grey, corneal opacity, develops A small grey, corneal opacity, develops
near the nasal limbusnear the nasal limbus
►The conjunctiva overgrows the opacity and The conjunctiva overgrows the opacity and progressively encroaches on to the corneaprogressively encroaches on to the cornea
►A deposit of iron (stockers line) may be A deposit of iron (stockers line) may be seen in the advancing head of pterygium seen in the advancing head of pterygium
CONJUNCTIVITISCONJUNCTIVITIS BACTERIAL CONJUNCTIVITISBACTERIAL CONJUNCTIVITIS►MucopurulentMucopurulent►Purulent Purulent ►MembranusMembranus►PseudomembranusPseudomembranus►Chronic bacterialChronic bacterial►Chronic angularChronic angular
MUCOPURULENT MUCOPURULENT CONJUNCTIVITISCONJUNCTIVITIS
SYMPTOMSSYMPTOMS► Redness, burning Redness, burning
and dischargeand discharge► PhotophobiaPhotophobia► Stickiness of eye lidStickiness of eye lid► Coloured haloes Coloured haloes
around the lightaround the light
MUCOPURULENT MUCOPURULENT CONJUNTIVITISCONJUNTIVITIS
SIGNSSIGNS►HyperaemiaHyperaemia► Papillary reactionPapillary reaction►Mucopurulent Mucopurulent
dischargedischarge► Lid oedemaLid oedema► Congestion and Congestion and
chemosischemosis
PURULENT CONJUNCTIVITISPURULENT CONJUNCTIVITISAdult gonococciAdult gonococci
SYMPTOMSYMPTOM
►Hyper acute Hyper acute conditioncondition
► Extremely profuse, Extremely profuse, thick, creamy puss thick, creamy puss
from the eyesfrom the eyes
MEMBRANOUS MEMBRANOUS CONJUNCTIVITISCONJUNCTIVITIS
SYMPTOMSSYMPTOMShighly toxic and ill highly toxic and ill patientpatientpyrexialpyrexialmembranemembrane
SIGNSSIGNShigh temperaturehigh temperaturelid edemalid edemamembranemembrane
ANGULAR CONJUNCTIVITISANGULAR CONJUNCTIVITIS► Adult infectionAdult infection
SYMPTOMSSYMPTOMS
► IrritationIrritation
► ItchingItching
► discomfortdiscomfort
ANGULARANGULAR CONJUNCTIVITISCONJUNCTIVITIS
SIGNSSIGNS►HyperemiaHyperemia► Excoriation of conj Excoriation of conj
epitheliumepithelium► Congestion at Congestion at
medial and latarl medial and latarl canthuscanthus
► Scanty Scanty mucopurulantmucopurulant dischargedischarge
CHLAMYDIALCHLAMYDIAL TRACHOMATRACHOMA►One of the One of the
leading cause of leading cause of preventable preventable blindness blindness
► Is a chronic Is a chronic keratoconjunctivikeratoconjunctivitis tis
TRACHOMATRACHOMA SYMPTOMSSYMPTOMS►FB sensationFB sensation► ItchingItching►Watering photophobia and rednessWatering photophobia and redness►Mucopurulent discharge if secondary Mucopurulent discharge if secondary
infectioninfection
TRACHOMATRACHOMA SIGNSSIGNS Conjunctival signsConjunctival signs► CongestionCongestion► Follicle Follicle ► Papillary Papillary
hyperplasiahyperplasia► Conj scarringConj scarring► ConcretionsConcretions
ALLERGIC CONJUNCTIVITISALLERGIC CONJUNCTIVITIS►Due to allergic or hypersensitivity Due to allergic or hypersensitivity
reactionreaction
►Conjunctiva is ten times more Conjunctiva is ten times more sensitive than the skin to allergenssensitive than the skin to allergens
► It is due to antigen antibody reactionIt is due to antigen antibody reaction
SIMPLE ALLERGIC SIMPLE ALLERGIC COJUNCTIVITISCOJUNCTIVITIS
SYMPTOMSSYMPTOMS
► ItchingItching
► RednessRedness
► LacrimationsLacrimations
SIMPLE ALLERGIC SIMPLE ALLERGIC CONJUNCTIVITISCONJUNCTIVITIS
SIGNSSIGNS► Swelling of the eye Swelling of the eye
lidlid►Mild chemosisMild chemosis►Diffuse papillary Diffuse papillary
responseresponse► Rarely cornea Rarely cornea
involvedinvolved
TREATMENTTREATMENT► Allergen removalAllergen removal► e/d corticosteroide/d corticosteroid► Tab antihistamineTab antihistamine► Combination of Combination of
vasoconstrictor with vasoconstrictor with antihistamine antihistamine
SPRING CATARRH(VKC)SPRING CATARRH(VKC)► Is a bilateral ,recurrent Is a bilateral ,recurrent
seasonal allergic seasonal allergic conjunctivitis in conjunctivitis in children(5-12 yrs)children(5-12 yrs)
► Cause-exogenous Cause-exogenous allergensallergens
TYPESTYPES► PALPEBRALPALPEBRAL► LIMBALLIMBAL►MIXEDMIXED
VKCVKC
SYMPTOMSSYMPTOMS► Intense itching Intense itching ► LacrimationLacrimation► Ropy dischargeRopy discharge► Photophobia Photophobia
burning and FB burning and FB sensationsensation
VKCVKC
SIGNSSIGNS►Giant papillaGiant papilla► PtosisPtosis► HyperaemiaHyperaemia►Mucus dischargeMucus discharge► Punctate Punctate
keratopathykeratopathy► Corneal ulcerCorneal ulcer► Coble stone papillaeCoble stone papillae
TREATMENTTREATMENT► Cold compressionCold compression► Topical steroidTopical steroid► Topical Topical
antihistamineantihistamine► Topical non Topical non
steriodial anti steriodial anti inflamatory drugsinflamatory drugs
GPCGPC► Inflammation of the Inflammation of the
conjunctiva with conjunctiva with formation of very formation of very large papillaelarge papillae
SYMPTOMSSYMPTOMS► Itching Itching ► String dischargeString discharge► Reduced wearing Reduced wearing
time of CLtime of CL
BITOT’S SPOTBITOT’S SPOT► Build up of keratin Build up of keratin
located superficially located superficially
►Oval triangular or Oval triangular or irregular in shapeirregular in shape
► Sign of vitamin A Sign of vitamin A deficiency deficiency
► Associated with Associated with conjunctival xerosisconjunctival xerosis
CONJUNCTIVAL XEROSISCONJUNCTIVAL XEROSIS►Dry,lustreless condition of the Dry,lustreless condition of the
conjunctiva.conjunctiva.►Due to vitamin A deficiency.Due to vitamin A deficiency.