L5 Conjunctival Signs & Degenerations

Jessica

PMN stands for

PMN stands for polymorphonuclear neutrophil

PTG stands for

pterygium

the conjunctival is made up of mucous membrane extending from the __________ junction to the ______ limbus

mucocutaneous

corneoscleral

1. free rotation of the globe

2. aids in normal eyelid function

3. protective barrier

4. production to tear film

5. ocular surface immunity

6. limbal stem cell maintenance

All are functions of

the conjunctiva

what 3 parts make up the conjunctiva

palpebral, bulbar and fornix

what are the two layers of the conjunctiva

epithelium and stroma

epithelium layer of the conjunctiva contains (3)

goblet cells, langerhan cells and dendritic melanocytes

t/f the conjunctival stroma is highly vascularized. contains nonstriated muscle, nerves, & fatty tissue

true

is the vascularization on the conjunctiva fenestrated? yes or no

yes

the palpebral conjunctiva shares common arterial blood supply as the ____ which are terminal branches of the _______ artery

lids

ophthalmic

t/f bulbar conjunctiva supply branches from the anterior ciliary artery form superficial plexus anastomose with vessels from palpebral conj

true

the junction between the conjunctiva and the cornea is known as the

corneoscleral limbus

conjuctival epithelium is continuous with ______ epithelium; although it is a different structure

corneal

where are the limbal stem cells stores

corneoscleral limbus

is the conjunctiva more or less organized than the cornea

less

cornea is more organized

what is the purpose of the limbal stem cells

renew and regenerative parts of the corneal epithelium

t/f the limbal stem cells act as barrier between conjunctiva and cornea

true. bc the difference in structure

if the stem cells are not working or injured how does that effect the cornea

poor epithelization or conjunctivalization of the cornea

conjunctival injections vessels are derived from anterior ciliary artery and ______ arteries

palpebral

1. superficial bright red blood vessels

2. fade towards corneoscelral limbus

3. easily moved

4. blanches with phenylephrine

all describe

conjunctival injection

1. no accompanying exudation or cellular infiltration

2. may be caused by smoke, fog, UV radiation, vasoconstrictor rebound

all describe

hyperemia

an acculumation of fluid within or beneath the conjunctiva is termed as

chemosis

the pathophysiology of chemosis begins with conjunctival capillaries ______ plasma proteins faster than fluid can pass between ______ cells

leak

epithelial

chemosis

papillae is a _____-mediated vascular reaction

histamine

papillae has nonspecific sign of inflammation resulting from ____ and ____ cell infiltration

edema , PMN

when papillae is found on upper tarsal what is its shape

flat topped

if papillae is found on the limbus, what is its shape

dome shaped

a patient who likes to we CL wants to keep wearing them. during bio microscopy the palpebral conjunctiva looks like it have flattened top with central fibrovascular core and the lower lid has similar but with a dome shape. what is that

papillae

giant papillary conjuctivitis is usually seen in what other conditions(3)

vernal conjunctivitis

atopic keratoconjunctivitis

foreign body reaction

how do giant papillary conjunctivitis occur

results from the breakdown of anchoring septae

where is GPC usually seen upper or lower tarsal conj

upper tarsal conj

usually GPC is greater than __mm in diameter

1mm

is GPC seen in immune or mechanical trauma. yes or no

yes

_____ have

1. yellowish white, discrete, round elevations of the conjunctiva

2. central portion is avascular, with BV going up over convexity from base

3.seen at limbus

4. 0.5-2mm diameter

follicles

what is the pathophysiology of follicles

a lymphocytic response with lymphoid germinal centers & central fibroblast

are follicles a non specific or specific inflammatory response

specific

follicles of childhood stay throughout adulthood

no, they go away with age

t/f folliculosis of childhood more prominent in fornix and fade towards lid margin

true

can follicular conjunctivitis been seen conditions like chlamydia, toxicity viruses such as herpes, adenovirus?

yes (CHAT)

when understanding if it papillae or follicle what aspect matters?

location

papillae

follicle

pathophysiology begins with fibrin that has attached to ______ epithelium

conjunctival

what is the different between true vs pseudomembranes

true: leaves raw surface * causes bleeding when peeled

pseudo: superficial little to no growth into conjunctival epithelium

a patient comes for a routine exam. they tell you they been diagnosed herpes simplex virus. later on you look into their eye and notice a white thick line on inferior palpebral conjunctiva. what is that

membrane

what is the number one cause of membranes

adenovirus

besides HSV and adenovirus what are other causes of membranes (3)

corynebacterium diptheriase, b-hemolytic streptococci & candida

membrane

____ are associated with

1. vernal conjunctivitis

2. inclusion conjunctivitis

3. ligneous conjunctivitis

4. steven johnson syndrome--> toxic epidermal necrolysis

membranes

t/f membranes can lead to

conjunctival scarring

goblet cell loss

entropion

trichiasis

limbal stem cell failure

true

ankyloblpeharon

symblepharon

______ is the scar formation secondary to desctruction of stromal tissue

cicatrization

it first starts as shortening of the fornix, stellate fibrosis

later it progresses to symblepharon

the end stage is obliteration of fornix, keratinization of epithelium AKA ankyloblepharon

what is it

ciciatrization

what condition is associated with cicatrization

ocular mucous membrane pemphigoid

granulomas

granuloma is:

cluster of immune cells nd other material secondary to inflammation

granuloma always affects the

stroma

t/f granulomas may be due to infectious or inflammatory eitology

true

t/f granulomas can be flat or evelated

true

granulomas have infectious causes such as (4)

parinaud oculoglandular syndrome

tularemia

TB

syphilis

exudate

what 3 classifications do exudate fall under

1. purulent or hyperactue

gono or meningitidis

2. mucopurulent (bacterial/chlamydial)

3. water (allergic/viral)

for the lymph nodes medially they drain into

submandiubular nodes

for lymph nodes laterally they drain into

preauricular nodes

lymphadenodopathy can occur in conjunctivitis.. which is more common viral or bacterial?

viral, usually ipsilateral

____ is a elevated, horizontally oriented area of bulbar conjunctival thickening within the palpebral fissure

pinguecla

pinguecula tend appear white to yellow fatty appearance unless ______ occurs

keratinazation

for pinguecula is the cornea involved? yes or no

no

are pinguecula unilateral or bilateral

bilateral

are pinguecula seen more commonly on nasal or temporal side

nasal

what two things increases chances of pinguecula

age & UV exposure

when looking at a pinguecula, what are other differentials (3)

ocular surface squamous neoplasia (OSSN)

limbal dermoid

other conjunctival tumors

if a pinguecula is inflamed its called

pingueculitis

if the pingueculitis is mild what is the best tx option

artificial tears

if the pingueculitis is moderate to severe what is the tx option

topical steroid= FML 0.1% or FML acetate 0.1% or loteprednol 0.2% 1gtt

or NSAID= ketorolac 0.4-0.5% QID

or

anti-histamine +/- bepotastine, ketotifen, olopatadine

_____ is a growth of fibrovascular tissue on the cornea and conjunctiva in palpebral fissure

does pterygium seen on nasal or temporal side

nasal

islets of vogt and stocker line are associated findings with

ptergyium

what are islets of vogt

elevated whitish opacities

what is stocker line

iron deposition line delineating head of pterygium

what is the pathogenesis of pterygium

damage to limbal stem cells by UV light & activation of matrix metalloproteinases

the difference between ptergium and pinguecuela is that pterygium is (2)

PTG is vascularized

PTG disrupts bowman membrane in the cornea

what are two causes of PTG (pterygium)

Uv light exposure

outdoor work

a patient comes to you complain about eyes being dry and vision is distorted. In the other eye its vision is gone. what could be diagnosis after bio microscopy?

pterygium

if diagnosing pterygium and one of the eyes of pt is occluded or gone. why is that

pterygium has reached the visual axis

OSSN/ CIN

pseudo pterygium

pinguecula

pannus

are ddx for_____

pterygium

pseudo pterygium

pannus

____ is the spectrum of squamos epithelial malignancies

OSSN

what is the most common nonpigmented conjunctival malignancy

OSSN

on the OCT, the _____ 3 distinction from it and pterygium

1. thickened epithelium

2. hyperreflective epithelium

3. abrupt transition from normal to abnormal epithelium

OSSN

top ptyergium

bottom OSSN

you should tx pterygium when its causing (5)

discomfort

encroachment of visual axis

significant astigmatism

cosmesis

should u tx a pterygium before cataract sx?

yes bc it induces unexpected astigmatism

how to tx pterygium mild cases (2)

artficial tears or UV exposure

how to tx moderate to severe pterygium (1)

surgical incision with conj autografting is "gold standard"

*common for it to come back

________________ is yellow, gray or black vertical bands anterior to insertion of MR or LR

senile scleral plaques

senile scleral plaques appear in the _____ but can be mistaken for degen or deposition

sclera