Conjunctiva

Causes for acute red eye

@CIKSA

conjuntivitis

iridocyclitis

keratitis

sub conjunctival hemorrhage

Acute congestive glaucoma

DD for red eye

Conjunctivitis, iriditis,keratitis,scleritis,episcleritis,sub conj hemm,Blepharitis, Corneal abrasion fb, chemical burn, glaucoma

Causes of conjunctival chemosis

Acute inflammation of conjunctiva,eyeball

Obstruction to circulation:orbital tumor, dysthyroid eye disease, pulsating exopthalmos,

Blood abnormalitis: Anaemia, urticaria, angioneurotic edema, nephritis

Sub conjunctival hemorrhage causes

-Trauma

-Straining

-Fragility of bvs:DM,HTN, Atherosclerosis,Nephritis,

-Severe conjunctivitis

-Serious head trauma

-Severe pressure on thorax

Conjunctivitis classsification

-ONSET

-DISCHARGE

-CONJUNCTIVAL RESPONSE

-AETIOLOGY;

Acute conjunctivitis(24 hrs-3weeks)

Staphylococcus aureus

Streptococcus pyogens

Hemophilus influenza

Hyper acute conjunctivits(12-24 hrs)

Neisseria gonorrhoea

Neisseria meningitidies

Chronic

Staphylococcus aureus

Moraxella lacunata

Enteric bacteria( Gram -ve bacilli)

Most common causative organism of viral conjunctivitis(iP;?)

Adenovirus

IP_8 days

Causes of viral conjunctivits

HE A Passionate MAN

Herpes simplex

Enterovirus

Adenovirus

Paramyxovirus

Myxovirus

Arborvirus

New Castlevrius

Forms of adenoviral conjunctivitis

-Epidemic keratoconjunctivitis(8,19)

-Non specific acute follicular conjunctivits(most common)(1-11,19)

-Pharngoconjunctivl fever(3,4,7)

-Chronic relapsing adenoviral conjunctivitis

Hyperendemic trachoma

Chlamydia trachomatis(A,B,Ba,C)

Pretrachoma

D to K

Acute inflmmatroy stage of trachoma signs

Conjunctival signs:

Congestion of upper tarsal +forniceal conjunctiva

Follicles

Pappillary hyperplasia

COrneal signs:

Herbert follicles: Follicles at limbal areas

Progressive pannus

Superficial keratitis

Phase of cicatrization signs

Conjunctival sign:

a. Conjunctival scarring: irregular scar, star shaped scar, linear scar-at sulcus subtarsalis-Arlt’s line.

b. Concretions; hard masses pinpoint to 2mm due to dead epithelial cells and mucus from glands of henle

c.xerosis,psuedocyst,symblepharon

Corneal signs:

Herbert pits:pval circular scars from healing of herbert follice\les

Regressive pannus

Corneal opacity

aru: lid;madarosis, entropion, ankyloblepharon, ptosis, trichiasis

lacrimal apparatus;chronic dacrocystitis, chronic dacroadenitis

Progressives vs regressive pannus

Progressive -area of infiltration ahead of vascularization

Regressive; vessels extend a short distance beyond the area of infiltration

WHO grading of trachoma

@FISTO
follicles;>5 follicles each follicle>0.5mm in upper tarsal conjunctiva

inflammatory intense; inflammatory thickening of upper tarsal conjunctiva>half of normal depth

Scarring

Trichiasis; one eyelash rubs eyeball/recent removal of inturned eyelashes

Corneal opacity; Coreal scarring that ibscures at least part of pupillary margin

Inclusion bodies of trachoma is called as

Halberstaedter Prowazeke

Treatment of choice of trachoma

Azithromycin ODX 4 days(20mg/kg up to 1gm)

Opthalmia neonatorum

Bilateral inflammation of conjunctiva occuring in an infant of less than 30 days old.

Etiology of ON

CHemical: AgNO3,ab used for prophylaxis(Creeds methos)

Infectious; Gonococcus, Chlamydia(d to k), Staphylococcus, streptococcus hemo,pyo, herpes simplex , NLD obstruction

Management of bacterial conjunctivitis

Topical;Chloramphenicol(1%), Tobramycin, Framycetin, Gentamycin(0.3%) OD

No response; quniolone ab;Ciprofloxacin, ofloxacin, moxifloxacin,gatifloxacin

Antinflammatory and analgesics

Treatment of viral conjunctivitis

Supportive treatment: Cold compression and sunglasses

decongestans and lubricants (methly celluose, hydroxymethylcelluloe,polyvinyl alcohol)

topical antiviral: Adenine arabinosides, cidofovir

topical ab

topical antiinflam

cycloplegics

Topical vasoconstrictors(Nafazolin)

Classification if allergic conjunctivitis

@VP le GAS chodxa

Vernal keratoconjunctivitis/Spring catarrah/ Warm weather conjunctivitis

Phlyctenular conjunctivitis

Giant Papillary conjunctivitis

Atopic Conjunctivits

Simple allergics; Season, Perennial

Type of reaction vernal ?

Type 1 hypersensitivity reaction

Symptoms of VK

Intense burning/itching

stringy ropy discharge

lacrimation

heaviness of eyelid

mild photophobia

Conjunctival signs in VK

-Palpebral form;

Hard flat topped papillae arranged in cobblestone or pavement stone in upper tarsal conjunctiva. papillae enlarge form cauliflower like mass called as giant papillary
Limbal form:

Dusky red triangular congestion of bulbar conjunctiva at inter palpebral site

gelatinous thickened accumulation of tissue around limbus

Horner tranta’s spots:white raised dots around the limbal area contains eosinophils.

Mixed form;both palpebral and limbal

Corneal signs in VK

Punctate keratitis

Ulcerative VK- shield ulcer

Corneal Plaques

Pseudogerontoxon

subepithelial scarring

Shield ulcer

formed due to deposition of calcium phosphate and mucin in micro erosions.

Maxwell Lyon Sign

Pseudomembrane formation due to execess mucus deposition in papillae. Can lead to keratoconus

Treatmen of VK

Topical anti inflammatory: MAN CTS

Mast cell stabilizers only; Na cromoglycolate, Nedocromil Na

Mast cell stabilizers+antihistaminics: Azelastine, ketotifen, Olopatadine

NSAIDS:Diclofenac,Ketorolac

Cyclosporine

Tacrolimus

Steroids: Fluorometholone, Medrysone

Topical lubraicant:Methyk cellulose

Topical mucolytics;Acetylcystine

Signs in atopic keratoconjunctivitis

Dennie MOrgan fold’ skin folds under the eye due to excessive rubbing

Hertoghe’s sign; Loss of lat 3rd of eyebrows

Madarosis: Loss of eyebrows and eyelashes

Inferior tarsal and forniceal conjunctivitis

Phlyctenular conjunctivitis definition

characteristic nodular affection in the form of allergic response of the conjunctiva and the corneal epithelium to some endogenous allergens to which they have becomes sensitized.

ENdogenous allergens for PK

Proteins of Staph aureus

Moraxella axenfeld

M TB

Parasite

Phlyctenular conjunctivitis

Simple; small whitish nodule surrounded by hyperemia near limbus.

Necrotizing

Milliary

Phlyctenular keratitis

Ulcerative; sacrofulous; formed by breakdown of small limbal phlycten

fascicular; forms ring ulcer. paralllel leash of bv

miliary

Diffuse infiltrative: central infiltration of cornea

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