Inflammatory and NonInflammatory Conditions of the Conjunctiva

Pemphigoid (Ocular Cicatricial Pemphigoid) pathophys

Autoimmune and chronic condition that causes subepithelial scarring of mucus membrane surfaces within the conjunctiva

signs/symptoms of Pemphigoid (Ocular Cicatricial Pemphigoid)

1. • Chronic unilateral conjunctivitis that progresses to bilateral

2. • Significant scarring

   1. palpebral conj will scar to bulbar conj = symblepharon

3. • Severe FBS and pain

what this

Ocular Cicatricial Pemphigoid

conj should be clear but its becoming white

how do you diagnose OCP

1. biopsy

   1. need to rule out all other kinds of auto immunes

how do we treat OCP

1. multidisciplinary approach w derm, oculoplastic, cornea

   1. • Combination of dry eye therapy, antibiotic ungs, punctal occlusion, topical steroids, mucus membrane grafts, and keratoprosthesis as an end stage treatment

2. KERATOPROSTHESIS

   1. limbal stem cells are dead so this is the best we got to keep the cornea viable

   2. last case scenario

Steven Johnson Syndrome

1. A life-threatening condition that can cause a painful rash, and blistering of the skin and mucus membranes that results in scarring of the ocular surface and lids

2. Immune complex–mediated hypersensitivity reaction caused by many agents

   1. • Medication

   2. • Infections

   3. • Auto immune conditions

   4. • Idiopathic in 50% of cases

what are the ACUTE ocular findings of SJS

1. – first 7-10 days

   1. • Mucopurulent or pseudomembranous conjunctivitis

   2. • Episcleritis and Iritis

what are the CHRONIC ocular findings of SJS

1. weeks after initial presentation

   1. • Symblepharon formation

   2. • entropion, trichiasis, and instability of the tear film.

   3. • Breakdown of the ocular surface leads to corneal scarring, neovascularization, and, in severe cases, keratinization of the entire eye

how do we treat SJS pt

1. consult w internal med

2. really, send to ER

3. ocular treatment - palliative mainly

   1. aggressive lubrication/ dry eye treatment

   2. uveitis

   3. pseudomembrane peel

   4. sx indication for symblepharon

Superior Limbic Keratoconjunctivitis (SLK)

Disease of the ocular surface characterized by bilateral chronic inflammation of the superior tarsal, bulbar conjunctiva and cornea

• True etiology is unknown but multifactorial

• Can be associated with DED, Sjogren’s, RA, mechanical friction

signs of Superior Limbic Keratoconjunctivitis (SLK)

• Superior epithelial defects and superficial punctate keratitis

sometimes have filaments —> liek when you rub dry skin and it rolls up

lissamine green stain

symptoms of Superior Limbic Keratoconjunctivitis (SLK)

Severe foreign body sensation, pain, photophobia, mucoid discharge, epiphora,

how do we treat SLK

1. • Essentially treating severe dry eye

   1. • Aggressive Lubrication-preservative free ATs every 2 hours and ung at bedtime

   2. • Cyclosporin .05% BID

   3. • Can consider acetylcysteine 10% ophthalmic solution or Mucomyst 2-4 times per day depending on severity —> washes away mucus and filaments

   4. • Epithelial defects- would add broad spectrum antibiotic drops such as ofloxacin QID

   5. • Follow up in about 1 week (if epi defects presents) and in about 2-4 weeks for further management

Parinauds Oculoglandular syndrome most common cause

1. Cat Scratch Disease (Bartonella henselae)

Parinauds Oculoglandular Syndrome

1. Characterized as a granulomatous conjunctivitis with lymphadenopathy

2. has conjunctival nodules

will Parinauds Oculoglandular Syndrome go away on its own

yes

some Dr use azithromycin

pathophys of Conjunctivochalasis

• Bilateral condition described has redundant, loose, non edematous bulbar conjunctiva

• Normal aging, mechanical forces

signs and symptoms of Conjunctivochalasis

• Ocular irritation, epiphora

what this

Conjunctivochalasis

grooves hold more tears

how do we treat Conjunctivochalasis

1. often asymptomatic

2. DED treatment including Restasis and Xiidra

   1. • Improve tear film stability and reduce ocular surface inflammation

3. • Surgical considerations

   1. • If severely symptomatic- can consider excision

pyogenic granuloma

A benign vascular growth that typically develops on the palpebral conjunctiva following surgery, trauma or inflammation

whats pyogenic granuloma look like

• Pedunculated, fleshy, red/pink mass

signs/symptoms of pyogenic granuloma

1. FBS/ minor pain

how do we treat pyogenic granuloma

1. sx

2. corticosteroids