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NON INFECTIOUS COJUNCTIVITISheera tharanendran
ETIOLOGYALLERGIC y IRRITANTS(physical,foreign bodies,radiation,contact lens use) y ENDOGENOUS OR AUTOIMMUNE y DRY EYE y TOXIC(chemical or drug induced) y IDIOPATHICy
ALLERGIC CONJUNCTIVITISVERNAL /SPRING CATARRH CATARRHAL PHLYCTENULAR (Eczematous)
EXOGENOUS ALLERGENS
ACUTE/ SUB ACUTE
ENDOGENOUS ALLERGENS
Acute or sub acute catarrhal conjunctivitisDefinition:acute or sub acute non specific urticarial reaction to allergen. y Etiology: y Endogenous allergen-protein of S.aureus in nose ,URT. y Exogenous allergen-pollens, flowers, contact with animals(horse,cat). y Chemicals,cosmetics,eyelash dyes y Drug-atropiney
Symptomsy y y
Signsy y y
Itching Watery secretion Marked redness of the conjunctiva
Congestion with multiple follicles Watery mucoid discharge Skin of lid red,swollen
DIFFERENTIAL DIAGNOSISCLINICAL FEATURES HYPERAEMIA BACTERIAL MARKED ALLERGIC LESS MARKED
EXUDATE
PURULENT/ MUCOPURULENT LESS
ROPY WHITE
EOSINOPHILS
MORE
TREATMENTRemoval of the allergen y Astringent lotions y Adrenaline solutions y Antihistamine drugs(1%Antistine privine,chlorpheneramine) y Mast cell stabilizers(sodium cromoglycate,ketotifen) y Corticosteroid dropsy
VERNAL CONJUNCTIVITISy
DEFINITION:Recurrent,bilateral,seasonal conjunctivitis occurs with onset of hot weather.
ETIOLOGY: y Exogenous allergens y Hypersensitivity reaction y Mediated by IgE y Accompanying EOSINOPHILIAy
SYMPTOMSy y y y y
Burning Itching Discomfort in bright light (photophobia) Lacrimation White ropy secretion
TYPESmixed
Palpebral form
Limbal/bulbar form
Palpebral formConjunctival hyperaemia and chemosis. y Papillary hypertrophy y Palpebral part shows multiple polygonal shaped nodules-cobblestones y Color-milky white due to thickened epithelium y Eosinophils increased.y
Bulbar formOpacification - limbus y Multiple nodules or wall of gelatinous thickening limbus. y Horner-Trantas dots discrete chalky white superficial spots.y
Complications-Keratopathy ComplicationsMainly due to corneal involvement y Buckley Classification- 5 clinical stages: 1. Superficial punctate keratitis 2. Epithelial macro erosion and ulceration 3. Plaque 4. Ring scar 5. Pseudogeron toxony
PUNCTATE EPITHELIOPATHY
MACROEROSION
CORNEAL PLAQUE
SUBEPITHELIAL SCARRING
PSEUDOGERONTOXON
Differential diagnosisFEATURES AGE SPRING CATARRH YOUNG(6-20Yrs) TRACHOMA ALL AGE UPPER LID AND UPPER FORNIX IRREGULAR MUCOPURULENT LEBERS CELLS NONE NONE
SITE OF PALPEBRAL-UPPER LID FOLLICLE/PAPILLAE LIMBAL-BULBAR CONJUNCTIVA ARRANGEMENT DISCHARGE CONJUNCTIVAL SCRAPING SEASONAL VARIATION ITCHING COBBLE STONE THICK,ROPY/STRINGY EOSINOPHILS SUMMER,SPRING MARKED
TREATMENT
Topical steroids Mast cell stabilizers Acetylcysteine Cold compresses,tinted glasses
GIANT PAPILLARY CONJUNCTIVITIS Definition : Specific allergic inflammation affecting the superior tarsal conjunctiva y Etiology : y soft contact lens wearers y post operative protruding sutures y ocular prosthesesy
SYMPTOMSy y y
SIGNSy
Itching Irritation Increased mucus production
Upper palpebral conjunctiva shows giant papillae
TREATMENTy y y y y
Discontinue or change type of contact lens Remove offending sutures Clean and polish occular prosthesis Mast cell stabilizer with artificial tears,antihistaminic drops,decongesants Topical steroids Supratarsal injection of steroid
Phlyctenular conjunctivitisDEFINITION: Allergic reaction of the conjunctiva caused by endogenous proteins characterised by formation of bleb or nodule near the limbus. y ETIOLOGY: y Caused by allergic reaction to endogenous bacterial protein such as tuberculosis.y
SymptomsDiscomfort y Irritation y Itching y Reflex lacrimationy
Signs Nodules-bulbar conjunctiva near the limbus Congestion
Clinical types1. 2. 3.
Phlyctenular conjunctivitis Phlyctenular Kerato-conjunctivitis Phlyctenular keratitis
Ulcerative phlyctenular keratitis
Diffuse infiltrative phlyctenular keratitis
DIFFERENTIAL DIAGNOSISFEATURES AGE NODULE MOBILITY SITUATION TENDERNESS ULCERATION PHLYCTEN CHILDREN GREY/YELLOW MOVABLE AT THE LIMBUS NO YES EPISCLERITIS ADULTS-WOMEN PINKISH RED IMMOVABLE TEMPORAL SIDE AWAY FROM THE LIMBUS YES NO
TreatmentCorticosteroids y Antibiotic y Atropine y Dark glasses /eyeshade
SUMMARYCATARRHAL-Ropy white exudate eosinophilia y VERNAL-exogenous allergen Palpebral-Cobblestone Bulbar-Horner trantas dots y PHLYCTENULAR-endogenous allergen Bleb near limbusy
y
THANK YOU..