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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