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.