IN THE NAME OF GOD

CONJUNCTIVA

HISTOLOGY OF CONJUNCTIVA

� Conjunctiva epithelium 2-5 layers

� Goblet cells ( mucus secreting ( in epithelium)

� Basal epithelial cells � Basal epithelial cells

� Conjuctival stroma

� Adenoid layer

� Accessory lacrima glands ( in stroma ) (galnds of krause & wolfring )

Etiology of conjunctivitis

� Bacterial

� Chlamydial

� Viral

� Richetisial

� Fungal � Fungal

� Parasitic

� Chemical

� Unknown etiology

� Associated with systemic disease

� Secondary to dacryocystitis

Cytology of conjunctivitis

� Epithelial edema

� Cellular death

� Exfoliation � Exfoliation

� Epithelial hypertrophy

� Chemosis

� Adenoid hypertrophy

� Proliferation of inflammatory cells

Symptoms of conjunctivitis

� F.B sensation

� Burning sensation

� Itching� Itching

� Sensation of fullness

� Photophobia

Signs of conjunctivitis

� Hyperemia

� Tearing

� Exudation

� Pseudotosis

� Papillary hypertrophy � Papillary hypertrophy

� Chemosis

� Folicles

� Membrane & pseudomembrane

� Granoloma

� Preuricular adenopathy

Bacterial conjunctivitis

� Acute purulent conjunctivitis

� Acute mucopurulent conjunctivitis

� Chronic bacterial conjunctivitis � Chronic bacterial conjunctivitis

Acute prulent conjunctivitis

� Neisseria gonorhea

� Neisseria menigitidis

Acute mucorpuralent conjunctivitis

� H. aegypticus

� Pnomococus

� Streptococus � Streptococus

� H. inflanzae

� E.coil

Chronic bacterial conjunctivitis

� Chronic dacriosystis

� Bacterial blepharitis

� Meibomiantis � Meibomiantis

� Ectropion

Laboratory finding

� Scarping of conjunctiva

� Gram stain

� Gimsa stain � Gimsa stain

� Culture & antibiogram

Chlamydial conjunctivitis

� Trachoma

� Inclusion conjunctivitis

Trachoma

� Clamidia trachomatis

� 400 million people affected

� Warm climate � Warm climate

Symptom and sign

� Incubation period 5-14 days

� No severe findings in inflants & children

� Acute or subacute in adults

Hypertension – exudates – chemosis follicle –� Hypertension – exudates – chemosis follicle –

papilla

� Panus – preauricular

� Herberts pits

� Scar formation

Laboratory finding

� P.M.N proliferation

� Plasma cells

� Leber cells ( macrophages ) � Leber cells ( macrophages )

� Follicle cells ( lymphoblast )

Complication

� Dry eye

� Loss of goblet cells

� Entropion

� Trichiasis Trichiasis

� Corneal opacity

� Corneal ulcer

� Corneal perforation

� Ptosis

� NLD abstraction

� Tetracycline 1-1.5 g/d 3-4 weeks

� Doxycyclin 100 mg bid 3 weeks

� Erytromycin 1 g/d 3 – 4 weeks � Erytromycin 1 g/d 3 – 4 weeks

� Topical t.x sulfamid – Tetracycline -

Erytromycin

Inclusion conjunctiva

� Chlamidial

� Mucopurulent

� Follicular in adults � Follicular in adults

Laboratory finding

� PMN proleferation

� No bacterial growth

� Intra cytoplamic inclusion body � Intra cytoplamic inclusion body

� T.x. the some as trachoma

Viral conjunctivitis

� Acute

� Chronic

Pharyngoconjunctival fever

� Fever 38- 40 c

� Sore throat

� Fulicular conjunctivitis

Mostly bilateral � Mostly bilateral

� Transient keratitis

� Adeno virus type 3-4-7

� Monoocular cell proleferation

� No bacterial grow in culture

Epidemic kerato conjunctivitis

� Bilateral follicular conjunctivitis

� Photophobia & tearing

� Round sub epithelial opacity � Round sub epithelial opacity

� Adeno virus type 8-19

� No TX is indicated

Herpes simplex virus conjunctivitis

� In young children

� Acute follicular conjunctivitis

� Occesionally with keratitis � Occesionally with keratitis

� Mono nuclear cell proliferation

Chronic viral conjunctivitis

� Molluscum contagiosuim

� Varicella zoster

� Measles � Measles

Allergic conjunctivitis

� Hay fever conjunctivitis

� Vernal keratoconluntivitis

� Atopic keratoconluntivitis� Atopic keratoconluntivitis

� Gaint papillary conjunctivitis

Hay fever conjunctivitis

� With allergic rinitis

� Itching tearing – redness chemosis

� Few eosinophlis � Few eosinophlis

� Tx : local vasconstrietors – cold

compression – antihistamin

Vernal keratoconjunctivitis

� Seasonal

� Children between 5-15 years

� Lasts for 5-10 years � Lasts for 5-10 years

� Boys more than girls

Signs & symptoms

� Severe itching

� Family HX of allergy

� Papillary hypertrophy of upper lid � Papillary hypertrophy of upper lid

� Horner Tanta's dots

� Strile corneal ulcer

� Eosinophilic proliferation

Treatment

� Topical and systemic steroid

� Topical disunion cromoglycate

� Vasocostrictors – cold compression � Vasocostrictors – cold compression

� travelling to a cool – moist climate

� Topical 1% cyclosporiom

Kertoconjunctivits sicca

� Jorgen's syndrome

� Kertoconjunctivits sicca

� Xeserostomia � Xeserostomia

� Connective tissue dysfunction ( arthritis )

K.C.S

� Kertoconjunctivits ( filamentary )

� Dry eye( ab nl schirmer test )

� D.x: lymphosytic & plasmacell infiltration of � D.x: lymphosytic & plasmacell infiltration of

the accessory salivary glands

Treatment

� Artificial tears

� Obliteration of the puncta

� Topical vit- A � Topical vit- A

Pingecula & pterygium

� Hyaline deposition & elastotic degeneration

� Steroids for relife of inflammation

� Sunglasses � Sunglasses

� Operation & removal of pterygium

� Recurrent is common

Misellaneous disorders of the conjunctiva

� Lymphangiectasis

� Congenital conjunctival lymphedema

� Cistinosis � Cistinosis

� Sub cojunctival hemorrhage

Ophthalmia neomatorum

� Any infection of the newborn conjunctiva

� Etiology

� 1-gnorrheal ophtalmia � 1-gnorrheal ophtalmia

� 2- inclosion blennorrhea

� 3- herpes simplex virus type 2

Treatment

� 1% silver nitrate crede prophilaxis

Eritromycin

Conjunctival tumors

� Benign tumors

� Malignant tumors

Benign tumors

� Nevuse

� Papillama

� Granulma

Dermoid tumor � Dermoid tumor

� Dermo lipoma

� Lymphoid hyperplasia

� Fibroma

� Angioma

Malignant tumors

� Carcinoma

� Malignant melanoma

� Lymphosarcoma � Lymphosarcoma

THE ENDTHE END