Conjunctiva

conjunctival cyst

fluid-filled sac on the conjunctiva

also known as inclusion or retention cyst

conjunctival concretions

deposits of mucous and calcium rubbing against epithelial cells

what causes conjunctival nevus

benign proliferation of melanocytes on the conj

what is diagnostic for a conjunctival nevus

inclusion cysts within the lesion

what is PAM

primary acquired melanosis

unilateral acquired pigmentation with indistinct margins common in elderly white people

prognosis of PAM

can be benign but has malignant potential

30% progress to melanoma

biggest risk factors of PAM becoming malignant

increased vascularity

increased growth

what causes conjunctival melanoma

uncontrolled proliferation of melanocytes on the conj

who gets conjunctival melanoma

almost exclusively caucasians around 50+

where do conjunctival melanomas arise from

most (50-75%) arise from PAM

some arise from conjunctival nevi

most important risk factor for progression to malignant conjunctival melanoma

thickness of lesion

most common site of metastasis of conjunctival melanoma

liver

most common conjunctival neoplasia in the US

CIN (conjunctival intraepithelial neoplasia)

is CIN malignant

CIN is premalignant

what can CIN progress to

squamous cell carcinoma

how does CIN present

elevated gelatinous mass with neo

10% are keratinized

where are most CINs located

limbus

how does presentation of CIN differ from conjunctival squamous cell carcinoma

SCC usually has a feeder vessel

what is a pyogenic granuloma

benign, pedunculated, red, vascular lesion of palpebral conj from trauma or chronic irritation

conjunctival granuloma

inflamed area on the conjunctival stromal tissue

can be from foreign bodies, trauma, infection, or systemic conditions

what age group most commonly gets bacterial conjunctivitis

kids

extremely rare in adults

what is the most common cause of bacterial conjunctivitis in kids

haemophilus influenzae

what is the most common cause of bacterial conjunctivitis in adults

staph aureus and s. epidermidis

s. aureus is catalase and coagulase positive

presentation of bacterial conjunctivitis

acute redness that starts in one eye and goes to both

FBS and lids stuck together

important that onset is acute

how long do symptoms last in bacterial conjunctivitis

can last up to 10-14 days

discharge in bacterial conjunctivitis

mucopurulent

can also be purulent

what is the most common cause of bacterial conjunctivitis and why

s. aureus

high association with blepharitis that can transfer to conjunctiva

what causes gonococcal conjunctivitis

neisseria gonorrhoeae

STD

what is used to diagnose gonococcal conjunctivitis

thayer-martin agar (chocolate agar)

what will a gram stain for gonococcal conjunctivitis look like

gram negative intracellular diplococci on chocolate agar (thayer-martin)

what is thayer-martin agar used to diagnose

chocolate agar

cultures for n. gonorrhoeae and h. influenzae

Hershey’s and Nestle chocolate

gonococcal conjunctivitis presentation

hyperacute onset of severe purulent discharge

chemosis with pseudomembranes

papillary reaction

preauricular lymphadenopathy (rare in regular bacterial conjunctivitis)

what can occur in severe gonococcal conjunctivitis cases and why

corneal ulceration

n. gonorrhoeae can invade intact corneal epithelium

what are systemic gonorrhea symptoms of men and women

men: purulent urethral discharge after 3-5 day incubation period

women: discharge less common, 50% are asymptomatic

what 2 symptoms seen in gonococcal conjunctivitis are typically only seen in viral conjunctivitis

preauricular lymphadenopathy

pseudomembranes

gonococcal conjunctivitis is the only bacteria to cause these symptoms

most common co-existing infection with gonorrhea

chlamydia

who most commonly gets adenoviral conjunctivitis

adults

symptoms associated with all types of adenoviral conjunctivitis

follicles, pseudomembranes, diffuse conjunctival hyperemia, follow systemic viral infection

3 types of adenoviral conjunctivitis

acute nonspecific follicular conjunctivitis

pharyngoconjunctival fever (PCF)

epidemic keratoconjunctivitis (EKC)

most common adenoviral conjunctivitis

acute nonspecific folliclular conjunctivitis

what serotypes cause acute nonspecific folliclular conjunctivitis

1-11, 19

acute nonspecific folliclular conjunctivitis presentation

follicles, diffuse red eye, tearing, mild discomfort

which viral conjunctivitis is most common in kids

PCF

aka swimming pool conjunctivitis

serotypes that cause PCF

3, 5, 7

PCF triad

follicles

low grade fever

pharyngitis (sore throat)

viral conjunctivitis that has corneal involvement

EKC

EKC serotypes

8, 19, 37

when do clinical symptoms occur in EKC

8 days after exposure

acute phase of EKC

1-2 weeks, superficial keratitis is common

what can be present after acute phase of EKC

subepithelial infiltrates

what viral conjunctivitis has preauricular lymphadenopathy most commonly

EKC

EKC rule of 8s

serotype 8

occurs 8 days after exposure

SEIs 8 days after onset of symptoms

presence of ____ in a patient with adenoviral infection is pathognomonic for EKC

palpable lymph node

what causes molluscum contagiosum

DNA pox virus spread through direct contact

what other disease needs to be considered if multiple molluscum nodules present

HIV or other immunodeficiency diseases

molluscum contagiosum presentation

1 or multiple waxy, umbilicated, dome-shaped nodules on lid

can have mild mucous discharge

what happens if molluscum nodules rupture

can cause follicular conjunctivitis or pannus

2 diseases that can present with unilateral follicular conjunctivitis and watery discharge

molluscum contagiosum

herpes simplex

what type of conjunctivitis is seasonal allergic conjunctivitis and what causes it

type 1 hypersensitivity reaction

usually caused by airborne allergens

what type of conjunctivitis is perennial allergic conjunctivitis and what causes it

type 1 hypersensitivity reaction

household allergies

who gets VKC and how long does it last

males under 10 in hot climates

often occurs in patients with atopic conditions (asthma, rhinitis)

lasts 2-10 years

when do seasonal outbreaks of VKC commonly occur

warm months

VKC discharge

thick mucus discharge

classic VKC sign

bilateral severe papillae on limbus or superior palpebral conj

what are papillae on limbus called

trantas dots

what are papillae on superior palpebral conj called

cobblestone papillae

corneal involvement in VKC

begins with punctate epithelial keratitis and coalesces into large erosions

causes plaque formation and localized ulceration

what is localized ulceration of the cornea called

shield ulcer

who gets AKC and what disease is it associated with

teens to middle aged adults

atopic dermatitis

what is atopic dermatitis

chronic eczema with itching and rash commonly diagnosed in babies

what ocular issue can be developed with severe atopic dermatitis

cataracts

what kind of reaction is AKC

type 1 and type 4 hypersensitivity

not seasonal

main symptom of AKC

bilateral itching of eyelids

AKC presentation

prominent outer lids, extra crease under eyes, atopic shiners, inferior papillae, corneal neo, cataracts

what ocular disease can develop with AKC

KCN from chronic eye rubbing

Dennie’s lines

extra crease under lid due to edema

what can be seen in severe AKC

formation of symblepharon

how does AKC differ from VKC

VKC has superior papillae while AKC has inferior papillae

VKC is seasonal

AKC has more lid involvement while VKC has more conj and cornea involvement

toxicity to medication causes (papillae/follicles)

follicles

what is a papillae

inflamed area of elevated conj with central vessel that is source of infiltration for eosinophils, mast cells, neutrophils, and lymphocytes