Disease of Conjunctiva

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Text of Disease of Conjunctiva

  • ASIAN MEDICAL INSTITUTE

    NISHANT KUMAR.

  • The most common extraocular disorderEtiology: infection of microorganism physical injuries chemical injuries allergic disorder immunological disorder nutritional deficiency

  • According to the cause: bacterial, chlamydial, viral, fungal, allergic conjunctivitis

    According to the course: acute, subacute and chronic

  • SymptomsForeign body sensationScratchingBurning Fullness around the eyesItching and tearing pain and photophobia

  • Hyperemia Tearing Exudation Pseudoptosis Papillary hypertrophyChemosis Follicless Pseudomembranes Ligneous conjunctivitisGranulomas Phlyctenules Preauricular lymphadenopathy

  • Hyperemia

    Hyperemia Ciliary flush

  • Bacterial serous, mucous and purulent

    Viral watery or serous

    Allergic one or xerophthalmia

    ropy filamentous

  • papillary hyperplasia: palpebral conjunctival epithelium

    follicular formation: accumulation of lymphocyte beneath the conjunctival epithelium

  • pseudomembrane or membrane : the exudation rich in fibrin from palpebral conjunctiva . Pseudomembrane: in baby and children, adenoviral, neonatal inclusion, streptococcal conj.

    True membrane: diphtheritic conj.

  • Clinical examination Cytologic examination

    smear of conjunctival and scaling smear of conjunctivaBacteriological examination

    bacterial culture and drug sensitive testVirus isolation and its antigenic detection

  • Remove pathogenic cause, take local phamacotherapy as major, systemic treatment as supplement if necessary1)instillation of eyedrops

    2)instillation of ointment 3)washing of conjunctival sac 4)systemic treatmentPrevention

  • Hyperacute purulent conjunctivitis with the strongest infectivity and large destructibilityEtiology: diplococcus gonorrhoeae adult: auto infection children: touch infection newborn: direct infection

  • Clinical findings 1)incubation period: 10h-2, 3d, acute onset 2)opthalmalgia, photophobia, tearing 3)swelling of the eyelids palpebral and bulbar hyperemia and chemosis secretion: serous-bloody-purulent-nong lou yan inflammatory pseudomembrane preauricular lymphadenectasis corneal ulcer and perforation

  • Diagnosis: clinical findings lab examination(Gram stain, G- diplococcus)

    Treatment: topical and systemic one is the same important

    Prevention be isolated to avoid infection and epidemic

  • Clinical finding:acute onset(1-3days), both eyetearing, foreign body and burning sensationconjunctival hyperemia, purulent secretion, palpebral swelling, spots of subconjunctival hemorrhage

    Ill process: 2 weeks

  • Etiology bacterial infection: acute-chronic or infection of bacterial with weak toxicitynon-infectious environment factors: dust, chemical smoke or gas and irritating eye drugscomplicated from other disorders

  • Clinical finding:chronic onset, both eyeitching, foreign body and asthenopia or no symptomsconjunctival hyperemiamucous secretion papillary and follicle hyperplasiaTreatment: give management according to different causes

  • Chlamydin psittaci: Chlamydia trachomatis: antigen:ABCBa DEFGHIJK

    trachoma genitourinary system inclusion conjunctivitis

  • Acute or subacute stage(1-2mon):photophobia, tearing, foreign body sensation 1)palpebral and bulbar conjunctival hyperemia 2)ropy secretion 3)papillary hyperplasia, follicles formation 4)corneal epithelitisbe cured without scar left

  • Acute stage

  • Chronic stage: superinfections or concomitant bacterial infections1)Conjunctival hyperemia 2)ropy secretion 3)papillary hyperplasia, follicles in upper fornix and palpebral conjunctiva conjunctival thickening scar white luster like tenden 4)corneal epithelitis trachomatous pannus

  • Chronic stage

  • Our country Mac CallansI Early stage of infiltration hyperemia and thickeningearly follicle and corneal panusI progressive stagepapillae and follicles, upper fornix is blurred,corneal panusII active stagepapillae and follicles, corneal panusII regressive stagescar,a little active lesionIII precicatricial stage

    III complete cicatricial stagescar, no active lesion and infectivityIV cicatricial stage

  • Entropion and trichiasisBlepharopatosisSymblepharon (lower fornix)Parenchymatous xerosis of conjunctivaChronic dacryocystitisCorneal pannus

  • 1)the vessels of upper fornix and palpebral conjunctiva are blurred, congested, papillary hyperplasia or follicle formation or both 2)corneal pannus 3)scar 4)trachomatous inclusionDiagnosis on the basis of the first plus one of other three antigenic test

  • Scar corneal pannus

  • Topical tetracyclin, erythromycin Systemic sulfadiazine rifampinOperative: sequelae and complication

  • Acute onset, strong infectivity, may be sporadic or epidemicEtiology: adenovirus, type 8, 19, 29 and 37.

  • Clinical findings: 1)incubation period: 5-7d. 2)foreign body sensation, itching, pain, photophopia and tearing 3)palpebral edema, conjunctival hyperemia and chemosis, less and watery secretion, follicles in palpebral and fornix conjunctiva, preauricular lymphadeectasis and tenderness 4)be cured after one week exacerbate: superfial punctate keratitis

  • Diagnosis: Acute folliclar cinjunctivitis superfial punctate keratitis preauricular lymphadenectasis neutrophialTreatment: no specific drug 1)antiviral:topical(mainly) and systemic-acyclic 2)antibiotic

  • Fulminant epidemic ocular infectionsEtiology: entero-virus type 70, picornavirus Coxsackie virus type A 24

  • Clinical findings: 1)incubation period: 24hr 2)ill course: self-limited, 10d or shorter 3)ophthalmagia, foreign body sensation, photophopia and tears 4)eyelid and conjunctiva red and swollen, watery secretion, follicular hyperplasis of palpebral conjunctiva, patchy hemorrhage on bulbar conjunctiva, preauricular lymphadenectasis 5) Transient fine punctate epithelial keratitis

  • Symptom:extreme itchingSign 1)palpebral type: papillary hyperplasia in the upper palpebral conjunctiva that like oval flat cobblestone, eosinophillia in secretion 2)corneal limbal type: collid tubercles at the corneal limbus 3)mixed type:

  • Treatment: 1)self-limited, no vision affected 2)general treatment: keep away proble sensitinogen 3)medical treatment: natrii cromoglycas corticosteroid

  • Immediated allergic antigen: pollen, contact lens, etc. Delayed one: various drugClinical findings: immediate type: dermatitis of palpebral skin, blepharitis, mild infiltrative conjunctivitis

  • Lab examination: degenerative epithelial cell, few polynuclear cells and mononuclear cells in secretionTreatment: 1)find out and get rid of sensitinogen 2)corticosteroid 3)3% boric solution 4)anti-allergic agents

  • Etiology: delayed reaction to protein of microorganism, mostly to mycobecterium tuberculosis and staphylococcus aureusClinical findings: herpetic tubercle may appear on the bulbar conjunctiva or limbus.

  • Etiology: unclear, outdoor workClinical findings: 1)hypertrophic bular conjunctiva and its subconjunctival tissue invade onto the cornea with the shape of tiangle 2)composed of head, neck, body. 3)progressive, stationary 4)differentiated with pseudopterygiumTreatment: operation

  • A degenerative lesion of the bulbar conjunctiva caused by the effect of ultraviolet raysClinical findings: a kind of whiteyellow amorphous subepithelial deposition near to the limbusTreatment: no needed

  • Pterygium Pingueculae

  • Concrement on the palpebral conjunctivaOld or those with chronic conjunctivitisWhite-yellow depositTreatment:

    no need be rejected

  • nevi Dermolipoma

    angioma

  • Squamous Malignant cell carcinoma melanoma

  • Caused by vascular rupture beneath the bulbar conjunctiva or by osmotic increase of vascular wallTreatment:

    1)find out the cause 2)good explanation