🔶
🔸 Anatomy of the Conjunctiva:
Thin transparent mucous membrane:
-Posterior surface of the lids: palpebral conjunctiva
- Anterior surface of the sclera: bulbar conjunctiva
🔸
- Forniceal
Continuous with the skin at the lid margin (mucocutaneous junction) and with the corneal
🔹
epithelium at the limbus
Palpebral conjunctiva:
- firmly adherent to the tarsus
🔹
- Vertically oriented blood vesseles
Bulbar conjunctiva:
- Loosely attached to the orbital septum in the fornices
- Has many folds
- Allows the eye to move and enlarges the secretory conjunctival surface Blood supply, lymphatics and nerve
- Loosely attached to Tenon’s capsule and the underlying sclera supply
🔶 🔸 Blood supply:
🔹
🔹 Common disorder
conjunctiva 🔸 Surface anatomy
Semi lunar fold- soft, movable, thickened fold of bulbar conjunctiva located at the inner 🔸
- Anterior ciliary and palpebral arteries
Lymphatics:
🔹 Sudden onset, bright red appearance
Caused by rupture of small conjunctival 🔸
canthus - arranged in superficial and deep layers, drain to the
🔹
vessels
Forceful coughing, sneezing, rubbing,
Caruncle- small, fleshy, epidermoid structure attached superficially to the inner portion of
the semilunar fold 🔸
preauricular and submandibular nodes
Nerve supply:
🔶
- ophthalmic division of fifth nerve
🔹 Rule out blood dyscrasias if bilateral
straining, increased BP
🔸Histology of conjunctiva: - Small number of pain fibers
🔻 Tx: reassurance; hemorrhage absorbs in 2-3
weeks
Conjunctival epithelium:
-2-5 layers of stratified columnar epithelial cells
- Superficial cells- contains mucus-secreting goblet cells
Subconjunctival Hemorrhage 🔸
- Basal cells- stains deeply and contains pigment
Conjunctival stroma
- Adenoid-contains lymphoid tissue; “follicle-like structures”; does not develop until after 2 to
3 months
- Fibrous-composed of connective tissue that attaches to the tarsal plate; loosely arranged over
▪️
the globe
Accessory lacrimal glands of Krause and Wolfring
- Glands of Krause- upper fornix
- Glands of Wolfring- lies at the superior margin of the upper tarsus
Bacterial Conjunctivitis
▪️
▪️ Self limited
Contagious
• Acute Strep.P,Staph A, H.Inf. 1-2 weeks
• Chronic- > 2 weeks
🔶 Pinguecula
▪️
• Corynebacterium Strep pyogenes Moraxella sp.
Hyperacute Severe forms caused by Neisseria gonorrhoeae,, rarely
Neisseria meningititis).
- Yellow nodules on the sides of the cornea
- Commonly inflammed (pingueculitis)
Degenerative Diseases of the 🔸 ACUTE ONSET UNILATERAL OR BILATERAL
🔶
- Usually no treatment, unless inflammed
•Redness
Pterygium Conjunctiva •watery then mucopurulent or purulent discharge
- Fleshy, triangular encroachment on the cornea • Lids swelling , stuck in the morning with dischargeSelf limited
- Risk factors: UV exposure, dry or windy envt
- Tx: excision of pterygium if indicated 🔸 HYPERACUTE BACTERIAL CONJUNCTIVITIS
• Usually caused by Neisseria G Hyperacute bacterial conjunctivitis
• Profuse purulent exudate
• Lymphadenopathy
• Chemosis
• Corneal involvement
• Needs immediate treatment (Admission)
Conjunctivitis
🔹Keratoconjunctivitis sicca: 🔹
🔹 Inflammation of the conjunctiva
• If not treated can cause corneal damage or eye loss.
- Associated with Sjogren’s syndrome
🔹 Mostly exogenous cause
Most common eye disease worldwide
🔸 Bacterial Conjunctivitis Course and prognosis:
Untreated: 1 -14 days
- Triad of xerostomia, connective tissue dysfunction,
xerosis Causes With proper treatment: 1-3 days
- More common in women
- Lacrimal gland is infiltrated with lymphocytes and 🔹Bacterial🔹Viral 🔹 Chlamydial
It is either allergic or infectious as:
Treatment:
• Topical antibiotics 4 times a day for one week
plasma cells • Hand washing and avoid towel sharing.
- Ocular presentation: conjunctival hyperemia, mucoid
discharge, diminished tear film 🔹REDNESS🔹 Foreign body sensation🔹 Lacrimation and secretions 🔹Burning
Symptoms of conjunctivitis
sensation🔹 Itching ( Allergy).
• For Neisseria: topical antibiotics ( hourly) + I.V antibiotics
• PLEASE DO NOT PRESCRIBE STEROIDS
- Treatment: tear film preservation, topical
cyclosporine 🔹 Photophobia ( if corneal involvement )
Conjunctiva 🔹
Pharyngoconjunctival Fever
🔹 Cicatricial pemphigoid 🔹
Signs of conjunctivitis Characterized by fever, sorethroat, mild tender
- Non specific chronic conjunctivitis that is 🔹
🔹
Hyperemia- most constant sign(conj injection)
Chemosis🔹 Papillary hypertrophy- bacterial, Allergic
Discharge( Watery-Mucoid - Purulent – MP)
preauricular lymphadenopathy and follicular
resistant to therapy Conjunctivitis due to Autoimmune
Disease 🔹 🔹
conjunctivitis in one or both eyes
🔹 Causative agent: Adenovirus 3,4,7
🔹Pseudomembrane
- Eventually leads to progressive scarring, Follicles- viral and chlamydial
obliteration of the fornices, entropion and
trichiasis
and membrane- adenoviral conjunctivitis,gonococcal and some
other bacterial conjunctivitides(Streptococcus spp., Corynebacterium
Viral Conjunctivitis
• Commonest
🔹Self
Conjunctival scrapings: mononuclear cells
limiting, usually lasts 10 days
🔹
- Biopsy: eosinophils diphtheriae),ligneous conjunctivitis and Stevens–Johnson syndrome. • Easily spread, epidemic form
🔹
Preaurical lymphadenopathy* viral –gonococcal
-chlamydial infections.
What about the VA?
• Usually bilateral
• Mild to severe 🔹
Epidemic Keratoconjunctivitis
🔹 Usually bilateral involvement
Pain, injection, tearing, photophobia, chemosis,
• Redness, lid swelling, tearing
• Watery
• Associated w/ fever, sore throat 🔹 Causative agent: Adenovirus 8, 19, 29, 37
conjunctival hyperemia, pseudomemebranes
• Photophobia ( if corneal involvement )
🔹
🔹 No specific therapy
🔸 Adenoviruses- usual etiology 90%
🔹 Spontanous resolution within 2-3 wks
› Most common cause of Membranous conjunctivitis
› Pharyngoconjunctival Fever (PCF) - types 3,7 🔹
🔹
Hand Wash, avoid eye rubbing .
Disinfection and avoid towel sharing .
🔸
› Epidemic Keratoconjunctivitis ( EKC 25%) - types 8, 19
Enterovirus 70, Coxsackievirus A24 - rare epidemics 🔹 Antibacterial agents in cases of bacterial
Cold compresses
superinfection
🔸
› Acute Hemorrhagic Conjunctivitis (AHC)
🔸 Varicella Zoster
🔸 Herpes Simplex
Measles
Treatment
- topical tetracycline and oral tetracycline or
Azithromycin
*(Systemic tetracycline should not be given to
pregnantOr children < 7 years old)
Chlamydial Conjunctivitis
🔸
🔸 Inclusion Conjunctivitis- serotypes D-K
Trachoma- serotypes A, B, C
🔸
WHO Trachoma grading(FISTO)
🔸 TF= Follicular
Benign
🔸
🔸
TI = Intense inflammation
TS= Scaring
🔸TT= Trichiasis Treatment
🔹
TO= Corneal opacification SAFE strategy
Surgery for trichiasis,
🔹 Antibiotics for active disease
🔹 🔹 Facial hygiene
🔹
Benign
1. Nevus 2. Papilloma 3. Dermoid tumor 4. Enviromental improvement
🔹
Lipodermoid/Dermolipoma
Malignant
1. Carcinoma 2. Malignant Melanoma
Conjunctival Tumors systemic tetracyclines, doxycycline,
azithromycin(of choice)
Malignant
Conjunctivitis
Ophthalmia Neonatorum
🔸
(Neonatal conjunctivitis)
🔸 First month of life
🔸
🔸
Chemical irritation = first few days
Gonococcal = first week
🔸 Staph= after one week
🔸 Chlamydia= 1-3 weeks
Herpetic = 1-2 weeks
🔸
Treatment
🔸 topical tetracycline and oral erythromycin
🔸 Severe cases should be investigated
Hospital admission &pediatric consultation
🔸
Acute Allergic Conjunctivitis
🔸 Commonly seen in children
🔸
🔸
Allergy to environmental element
itching, tearing, redness
🔻Chemosis is the hallmark
Treatment: not required , cold compress
🔸
Seasonal (Hay fever) conjunctivitis
🔸Commonly associated with allergic rhinitis
Allergic Conjunctivitis:
🔸
🔸
Sneezing and nasal discharge .
Acute or subacute itching, tearing, redness
Immunologic/Allergic Conjunctivitis
🔸 Itching: severe 🔺Treatment:
Mild Papillary reaction& -/+ lid oedema
stabilizers
topical antihistamines; mast-cell
🔸 Hyperemia: generalized
🔸Stained scrapings & exudates: eosinophils
🔸Tearing: moderate 🔸
Limbal VKC
Gelatinous limbal papillae with white
🔸 Exudation: minimal cellular collections (HT spots).
by fatema okoff
🔸 Acute 🔸Seasonal🔸 Vernal KC
Allergic Conjunctivitis
🔸 Papebral 🔸 Limbal🔸Mixed
Classification of VKC
🔸
VKC (Vernal Keratoconjunctivitis)
🔸 “Spring catarrh”
🔸
🔸
Begins in early childhood and lasts for 5-10 years
boys> girls
🔸
🔸
Common in warm countries
+ve family h/o allergic diseases in 40%
🔸
🔸 Itching 🔸photophobia
Flares during spring
Presentation: milky appearance of conj; stringy
🔸
discharge
Cobble stone appearance of upper palpebral
conjunctiva
VKC
🔺
🔸 Treatment:
🔸
🔸
Mast cell stabilizer
Antihistamines
🔸 Cold compresses, air-conditioned rooms
🔸Supratarsal
Short course topical stroids* indications
steroid injection
🔸 Anatomy of the Conjunctiva:
Thin transparent mucous membrane:
-Posterior surface of the lids: palpebral conjunctiva
- Anterior surface of the sclera: bulbar conjunctiva
🔸
- Forniceal
Continuous with the skin at the lid margin (mucocutaneous junction) and with the corneal
🔹
epithelium at the limbus
Palpebral conjunctiva:
- firmly adherent to the tarsus
🔹
- Vertically oriented blood vesseles
Bulbar conjunctiva:
- Loosely attached to the orbital septum in the fornices
- Has many folds
- Allows the eye to move and enlarges the secretory conjunctival surface Blood supply, lymphatics and nerve
- Loosely attached to Tenon’s capsule and the underlying sclera supply
🔶 🔸 Blood supply:
🔹
🔹 Common disorder
conjunctiva 🔸 Surface anatomy
Semi lunar fold- soft, movable, thickened fold of bulbar conjunctiva located at the inner 🔸
- Anterior ciliary and palpebral arteries
Lymphatics:
🔹 Sudden onset, bright red appearance
Caused by rupture of small conjunctival 🔸
canthus - arranged in superficial and deep layers, drain to the
🔹
vessels
Forceful coughing, sneezing, rubbing,
Caruncle- small, fleshy, epidermoid structure attached superficially to the inner portion of
the semilunar fold 🔸
preauricular and submandibular nodes
Nerve supply:
🔶
- ophthalmic division of fifth nerve
🔹 Rule out blood dyscrasias if bilateral
straining, increased BP
🔸Histology of conjunctiva: - Small number of pain fibers
🔻 Tx: reassurance; hemorrhage absorbs in 2-3
weeks
Conjunctival epithelium:
-2-5 layers of stratified columnar epithelial cells
- Superficial cells- contains mucus-secreting goblet cells
Subconjunctival Hemorrhage 🔸
- Basal cells- stains deeply and contains pigment
Conjunctival stroma
- Adenoid-contains lymphoid tissue; “follicle-like structures”; does not develop until after 2 to
3 months
- Fibrous-composed of connective tissue that attaches to the tarsal plate; loosely arranged over
▪️
the globe
Accessory lacrimal glands of Krause and Wolfring
- Glands of Krause- upper fornix
- Glands of Wolfring- lies at the superior margin of the upper tarsus
Bacterial Conjunctivitis
▪️
▪️ Self limited
Contagious
• Acute Strep.P,Staph A, H.Inf. 1-2 weeks
• Chronic- > 2 weeks
🔶 Pinguecula
▪️
• Corynebacterium Strep pyogenes Moraxella sp.
Hyperacute Severe forms caused by Neisseria gonorrhoeae,, rarely
Neisseria meningititis).
- Yellow nodules on the sides of the cornea
- Commonly inflammed (pingueculitis)
Degenerative Diseases of the 🔸 ACUTE ONSET UNILATERAL OR BILATERAL
🔶
- Usually no treatment, unless inflammed
•Redness
Pterygium Conjunctiva •watery then mucopurulent or purulent discharge
- Fleshy, triangular encroachment on the cornea • Lids swelling , stuck in the morning with dischargeSelf limited
- Risk factors: UV exposure, dry or windy envt
- Tx: excision of pterygium if indicated 🔸 HYPERACUTE BACTERIAL CONJUNCTIVITIS
• Usually caused by Neisseria G Hyperacute bacterial conjunctivitis
• Profuse purulent exudate
• Lymphadenopathy
• Chemosis
• Corneal involvement
• Needs immediate treatment (Admission)
Conjunctivitis
🔹Keratoconjunctivitis sicca: 🔹
🔹 Inflammation of the conjunctiva
• If not treated can cause corneal damage or eye loss.
- Associated with Sjogren’s syndrome
🔹 Mostly exogenous cause
Most common eye disease worldwide
🔸 Bacterial Conjunctivitis Course and prognosis:
Untreated: 1 -14 days
- Triad of xerostomia, connective tissue dysfunction,
xerosis Causes With proper treatment: 1-3 days
- More common in women
- Lacrimal gland is infiltrated with lymphocytes and 🔹Bacterial🔹Viral 🔹 Chlamydial
It is either allergic or infectious as:
Treatment:
• Topical antibiotics 4 times a day for one week
plasma cells • Hand washing and avoid towel sharing.
- Ocular presentation: conjunctival hyperemia, mucoid
discharge, diminished tear film 🔹REDNESS🔹 Foreign body sensation🔹 Lacrimation and secretions 🔹Burning
Symptoms of conjunctivitis
sensation🔹 Itching ( Allergy).
• For Neisseria: topical antibiotics ( hourly) + I.V antibiotics
• PLEASE DO NOT PRESCRIBE STEROIDS
- Treatment: tear film preservation, topical
cyclosporine 🔹 Photophobia ( if corneal involvement )
Conjunctiva 🔹
Pharyngoconjunctival Fever
🔹 Cicatricial pemphigoid 🔹
Signs of conjunctivitis Characterized by fever, sorethroat, mild tender
- Non specific chronic conjunctivitis that is 🔹
🔹
Hyperemia- most constant sign(conj injection)
Chemosis🔹 Papillary hypertrophy- bacterial, Allergic
Discharge( Watery-Mucoid - Purulent – MP)
preauricular lymphadenopathy and follicular
resistant to therapy Conjunctivitis due to Autoimmune
Disease 🔹 🔹
conjunctivitis in one or both eyes
🔹 Causative agent: Adenovirus 3,4,7
🔹Pseudomembrane
- Eventually leads to progressive scarring, Follicles- viral and chlamydial
obliteration of the fornices, entropion and
trichiasis
and membrane- adenoviral conjunctivitis,gonococcal and some
other bacterial conjunctivitides(Streptococcus spp., Corynebacterium
Viral Conjunctivitis
• Commonest
🔹Self
Conjunctival scrapings: mononuclear cells
limiting, usually lasts 10 days
🔹
- Biopsy: eosinophils diphtheriae),ligneous conjunctivitis and Stevens–Johnson syndrome. • Easily spread, epidemic form
🔹
Preaurical lymphadenopathy* viral –gonococcal
-chlamydial infections.
What about the VA?
• Usually bilateral
• Mild to severe 🔹
Epidemic Keratoconjunctivitis
🔹 Usually bilateral involvement
Pain, injection, tearing, photophobia, chemosis,
• Redness, lid swelling, tearing
• Watery
• Associated w/ fever, sore throat 🔹 Causative agent: Adenovirus 8, 19, 29, 37
conjunctival hyperemia, pseudomemebranes
• Photophobia ( if corneal involvement )
🔹
🔹 No specific therapy
🔸 Adenoviruses- usual etiology 90%
🔹 Spontanous resolution within 2-3 wks
› Most common cause of Membranous conjunctivitis
› Pharyngoconjunctival Fever (PCF) - types 3,7 🔹
🔹
Hand Wash, avoid eye rubbing .
Disinfection and avoid towel sharing .
🔸
› Epidemic Keratoconjunctivitis ( EKC 25%) - types 8, 19
Enterovirus 70, Coxsackievirus A24 - rare epidemics 🔹 Antibacterial agents in cases of bacterial
Cold compresses
superinfection
🔸
› Acute Hemorrhagic Conjunctivitis (AHC)
🔸 Varicella Zoster
🔸 Herpes Simplex
Measles
Treatment
- topical tetracycline and oral tetracycline or
Azithromycin
*(Systemic tetracycline should not be given to
pregnantOr children < 7 years old)
Chlamydial Conjunctivitis
🔸
🔸 Inclusion Conjunctivitis- serotypes D-K
Trachoma- serotypes A, B, C
🔸
WHO Trachoma grading(FISTO)
🔸 TF= Follicular
Benign
🔸
🔸
TI = Intense inflammation
TS= Scaring
🔸TT= Trichiasis Treatment
🔹
TO= Corneal opacification SAFE strategy
Surgery for trichiasis,
🔹 Antibiotics for active disease
🔹 🔹 Facial hygiene
🔹
Benign
1. Nevus 2. Papilloma 3. Dermoid tumor 4. Enviromental improvement
🔹
Lipodermoid/Dermolipoma
Malignant
1. Carcinoma 2. Malignant Melanoma
Conjunctival Tumors systemic tetracyclines, doxycycline,
azithromycin(of choice)
Malignant
Conjunctivitis
Ophthalmia Neonatorum
🔸
(Neonatal conjunctivitis)
🔸 First month of life
🔸
🔸
Chemical irritation = first few days
Gonococcal = first week
🔸 Staph= after one week
🔸 Chlamydia= 1-3 weeks
Herpetic = 1-2 weeks
🔸
Treatment
🔸 topical tetracycline and oral erythromycin
🔸 Severe cases should be investigated
Hospital admission &pediatric consultation
🔸
Acute Allergic Conjunctivitis
🔸 Commonly seen in children
🔸
🔸
Allergy to environmental element
itching, tearing, redness
🔻Chemosis is the hallmark
Treatment: not required , cold compress
🔸
Seasonal (Hay fever) conjunctivitis
🔸Commonly associated with allergic rhinitis
Allergic Conjunctivitis:
🔸
🔸
Sneezing and nasal discharge .
Acute or subacute itching, tearing, redness
Immunologic/Allergic Conjunctivitis
🔸 Itching: severe 🔺Treatment:
Mild Papillary reaction& -/+ lid oedema
stabilizers
topical antihistamines; mast-cell
🔸 Hyperemia: generalized
🔸Stained scrapings & exudates: eosinophils
🔸Tearing: moderate 🔸
Limbal VKC
Gelatinous limbal papillae with white
🔸 Exudation: minimal cellular collections (HT spots).
by fatema okoff
🔸 Acute 🔸Seasonal🔸 Vernal KC
Allergic Conjunctivitis
🔸 Papebral 🔸 Limbal🔸Mixed
Classification of VKC
🔸
VKC (Vernal Keratoconjunctivitis)
🔸 “Spring catarrh”
🔸
🔸
Begins in early childhood and lasts for 5-10 years
boys> girls
🔸
🔸
Common in warm countries
+ve family h/o allergic diseases in 40%
🔸
🔸 Itching 🔸photophobia
Flares during spring
Presentation: milky appearance of conj; stringy
🔸
discharge
Cobble stone appearance of upper palpebral
conjunctiva
VKC
🔺
🔸 Treatment:
🔸
🔸
Mast cell stabilizer
Antihistamines
🔸 Cold compresses, air-conditioned rooms
🔸Supratarsal
Short course topical stroids* indications
steroid injection
