Conjunctival Disorders

Abdulrahman Al-Amri, MD

ObjectivesObjectives AnatomyAnatomy

– Classification Classification – HistologyHistology

PhysiologyPhysiology PathologyPathology

– Conjunctivitis Conjunctivitis – Conjunctival lesionsConjunctival lesions

CONJUNCTIVITISCONJUNCTIVITIS

InfectiousInfectiousBacterial Bacterial ViralViral

InflammatoryInflammatoryAllergicAllergic

– Seasonal Seasonal – Vernal Keratoconjunctivitis (VKC)Vernal Keratoconjunctivitis (VKC)

NeoplasticNeoplastic

Conj. LesionsConj. Lesions

BenignBenign– PterygiumPterygium– NevusNevus

MalignantMalignant– MelanomaMelanoma– SCCSCC

AnatomyAnatomy

Mucous membraneMucous membrane

1.1. PalpebralPalpebral

2.2. Forniceal Forniceal

3.3. BulbarBulbar

HistologyHistology EpitheliumEpithelium

Goblet cellsGoblet cells

StromaStroma Lymphoid tissueLymphoid tissue

PhysiologyPhysiology

Mucin layer of tear filmMucin layer of tear film

SignsSigns

Hyperemia Hyperemia Discharge:Discharge:

– Watery (viral, allergic)Watery (viral, allergic)– Mucoid (vkc)Mucoid (vkc)– Purulent (gonococcal) Purulent (gonococcal)

FolliclesFollicles(Lymphoid Hyperplasia)(Lymphoid Hyperplasia)

PapillaePapillae vessles surrounded by stromal vessles surrounded by stromal edema and epith hyperplasiaedema and epith hyperplasia

Pseudomembrane Pseudomembrane (fibrin exudation)(fibrin exudation)

Pathology Pathology

Symptoms Symptoms

– Redness Redness – FB sensationFB sensation– DishargesDisharges– CL useCL use– VisionVision

ExaminationExamination

VAVA

HyperemiaHyperemia Disharges &crustsDisharges &crusts ChemosisChemosis

PapillaePapillae Cornea…Cornea…

Bacteriology Bacteriology – Gm +ve*Gm +ve*– Gm -veGm -ve

Diagnosis

Bacterial conjunctivitis

TreatmentTreatment

Indications for specialist Indications for specialist referralreferral

Change in visual acuityChange in visual acuity– Evidence of keratitisEvidence of keratitis– Anterior uveitisAnterior uveitis

Severe eye painSevere eye pain Failure to improve or worsening of Failure to improve or worsening of

symptoms in spite of treatment.symptoms in spite of treatment.

•Purulent discharge•Hyperaemia •Chemosis

• Corneal ulceration…

Signs Complications

Gonococcal Gonococcal keratoconjunctivitiskeratoconjunctivitis

Management Management

Take scraping:Take scraping:– Gm stainingGm staining– C&S.C&S.

RxRx??

Topical Topical

gentamycingentamycin

Ceftriaxone IVCeftriaxone IV

SymptomsSymptoms

– Dischage …Dischage …– RednessRedness– Lid swellingLid swelling– FB sensationFB sensation– Vision* Vision*

SignsSigns

Lymphadenopathy Lymphadenopathy Lid edema, SCHLid edema, SCH Follicles,PseudomembraneFollicles,Pseudomembrane Keratopathy Keratopathy

Viral conjunctivitisViral conjunctivitis

RxRx? ?

Strict hygieneStrict hygiene::– Sharing of towelsSharing of towels– Hand washingHand washing– Touching the eyeTouching the eye– Shaking handsShaking hands

Cold compressesCold compresses Lubricants Lubricants VasocostrictorVasocostrictor

– Naphazoline/pheniramine gtt(Q6hrs 1wk)Naphazoline/pheniramine gtt(Q6hrs 1wk)

SymptomsSymptoms SignsSigns::

– Lid edemaLid edema– Lid vesiclesLid vesicles– Follicles Follicles – KeratopathyKeratopathy– LymphLymph..

Herpes simplex Herpes simplex conjunctivitisconjunctivitis

RxRx? ?

RxRx

Acyclovir ointAcyclovir oint

Neonatal chlamydial conjunctivitis

Treatment

Mucopurulent DischargesPapillary conjunctivitis*Systemic

OtitisPeumonia

DxGiemsa stainIF

- topical and oral antibiotics

TrachomaTrachoma

Chronic disease Infection with serotypes A, B,

and C of Chlamydia trachomatisCommon fly..poor hygiene

Chronic disease

Infection with serotypes A, B,

and C of Chlamydia trachomatis

Common fly..poor hygiene

WHO Grading

TF FolliclesTI InflammationTS ScarringTT Trichiasis CO Corneal Opacity

Herbert's pits

DxDx

Clinical*Clinical* Immunofluorescent stainingImmunofluorescent staining

RxRxTopical: Topical:

–Tetracycline ointTetracycline ointSystemic AntibioticsSystemic Antibiotics

–DoxyDoxy–Erythromycin Erythromycin –AzithromycinAzithromycin

Art. TearsArt. TearsSurg Surg

CommonCommon Type IType I SymptomsSymptoms

– ItchingItching SignsSigns

– PapillaePapillae

Allergic conjunctivitisAllergic conjunctivitis

RxRx

Precipitating factorsPrecipitating factors Cold compressesCold compresses Topical antihistamineTopical antihistamine Mast cell stabilizer: if chronicMast cell stabilizer: if chronic Steroid: if severeSteroid: if severe

Vernal keratoconjunctivitis VKCVernal keratoconjunctivitis VKC

Type IType I Cell-mediatedCell-mediated History History

– ItchingItching– Discharge ..Discharge ..

PapillaePapillae H-Trantas dotsH-Trantas dots

Trantas dots

Trantas dots

ComplicationsComplications

CorneaCornea– scarscar

RX:RX:o Mast cell stabilizer+antihistMast cell stabilizer+antihisto SteroidSteroido Immunosuppresion Immunosuppresion

Conjunctival lesionsConjunctival lesions

Pigmented Pigmented Benign Benign

– Nevus Nevus MalignantMalignant

– melanomamelanoma

Non-pigm Non-pigm Benign Benign

– PapillomaPapilloma– Pterygium Pterygium

Malig: Malig: – SCCSCC

Conjunctival lesionsConjunctival lesions

Pigmented :Pigmented : Benign Benign

– Nevus Nevus melanocytesmelanocytes

MalignantMalignant

– melanomamelanoma

Non-pigm Non-pigm Benign Benign

– papillomapapilloma Malig: Malig:

– SCCSCC

Conjunctival lesionsConjunctival lesions

Pigmented :Pigmented : Benign Benign

– Nevus Nevus

MalignantMalignant– melanomamelanoma

Non-pigm Non-pigm Benign Benign

– papillomapapilloma Malig: Malig:

– SCCSCC

Conjunctival lesionsConjunctival lesions

Pigmented :Pigmented : Benign Benign

– Nevus Nevus

MalignantMalignant– melanomamelanoma

Non-pigm Non-pigm Benign Benign

– papillomapapilloma Malig: Malig:

– SCCSCC

ReviewReview Anatomy Anatomy Symptoms, SignsSymptoms, Signs

CONJUNCTIVITISCONJUNCTIVITIS:: Bacterial conjBacterial conj ViralViral allergic allergic Vernal keratoconjunctivitis: VKCVernal keratoconjunctivitis: VKC Conj. lesionsConj. lesions

ExamExam

…… …… may be seen inmay be seen in GlaucomaGlaucoma TrachomaTrachoma Herpes simplexHerpes simplex VKCVKC Ophthalmia neonatorumOphthalmia neonatorum

Thanks