Conjunctiva Flashcards

Question

What is the world leading cause of preventable irreversible blindness

Answer 1

recurrent infection elicits a chronic immune response consisting of a cell-mediated delayed hypersensitivity (Type IV) reaction to the intermittent presence of chlamydial antigen and can lead to loss of sight

Answer 2

Active: pre school children with mixed follicular/papillary conjunctivitis, mucopurulent discharge. Children <2 papillary component dominates, epithelial keratitis + pannus Cicatricial trachoma: middle age. Linear or stellate conj scars in mild/ broader confluent scars. Arlt line in severe disease. Upper tarsal plate most commonly involved.Superior limbal follicles Herbert pits. Trichiasis/ distichiasis/ CoNV, cicatricial entropion, Dry eye from goblet cell loss + lacrimal gland loss

Answer 3

TF- Trachoma inflammation follicular 5 or more follicles >0.5mm, on superior tarsal plate TI- Trachoma inflammation intense diffuse involvement of tarsal conj obscuring 50% or more of normal deep tarsal vessels TS- Trachoma conj scarring: easily visible fibrous white tarsal bands TT- Trachoma trichiasis at least one lash touching globe CO- Corneal opacity blur details of pupil margin

Answer 4

SAFE: Surgery for trichiasis (relieve entropion/ trichiasis/ bilamellar tarsal rotation) Abx for active disease (single dose Azithromycin) Facial hygiene Environmental improvement

Answer 5

conjunctival inflammation developing within the first month of life. Occurs in upto 10% of neonates. Often result of infection transmitted from mother to infant during delivery

Answer 6

Acquired organisms during vaginal delivery. C trachomitis/ N gonorrhoea. HSV2. C trachomitis most common cause for moderate- severe conjunctivitis Staph mild conjunctivitis. Strep/H influenza/ Gram neg organisms Congenital NLDO

Answer 7

Chemical irritation: first few days Gonococcal first week Staph other bacteria: end of the first week HSV 1-2 weeks Chlamydia 1-3 weeks

Answer 8

Congenital glaucoma

Answer 9

Parental prenatal STI testing results Conj scrapings for NAAT/ PCR chlamydia HSV Conj scrapings on glass slide for gram/ giemsa stain. Multi nucleated giant cells seen on gram stain in HSV Conj swabs for standard bacterial culture/ chocolate agar/ thayer martin for gonorrhoea

Answer 10

Prophylaxis routinely performed but no standard protocol. Single instillation of povidone iodine 2.5% effective. Erythromycin 0.5% or tetracycline 1% ointment. Silver nitrate 1% agglutinates gonococci + IM Benpen Chlamydia- oral erythromycin for 2 weeks. Longer course may be needed Gonococcal- third generation cephalosporin + topical treatment. Co- treat for chlamydia HSV- High dose intravenous aciclovir +/- LP if encephalitis GUM/ paeds involvement

Answer 11

Adenoviral (90%) non enveloped double stranded DNA virus

Answer 12

Non specific acute follicular conjunctivitis Pharyngoconjunctival fever (PCF)- adenovirus serovasrs 3,4,7 Epidemic Keratoconjunctivitis (EKC)- Adenovirus serovars 8, 19, 37 Acute haemorrhagic conjunctivitis Chronic/relapsing adenoviral conjunctivitis Herpes simplex virus Systemic viral infections Molluscum contagiosum (human specific ds DNA pox virus) SARS Cov2 virus

Answer 13

eyelid oedema lymphadenopathy conj hyperaemia + follicles severe inflammation associated with haemorrhages petechial in adenoviral/ pseudomembranes. Membranes rare Keratitis (Adenoviral) epithelial microcysts, Punctate epithelial keratitis , focal white subepithelial anterior stromal infiltrates Mild AAU Mollluscum- pale waxy unbilicated nodule on lid margin + follicular conjunctivitis

Answer 14

Giemsa stain- mononuclear cells in adenoviral conjunctivitis + multinucleated cells in herpetic infection NAAT- PC R test Viral culture Point of care immunochromatography Serology for IgG/IgM

Answer 15

Spontaneous resolution 2-3 weeks adenoviral Handwashing Molluscum- self limiting but removal often necessary to address secondary conjunctivitis/cosmetic reasons. Topical steroids- pred 0.5% qds, for severe (pseudo) membranous conjunctivitis Lubricants Povidone iodine 5%

Answer 16

IgE T1 hypersensitivity reaction

Answer 17

differ in timings of exacerbations seasonal- hay fever eyes worse in spring and summer perennial- symptoms throughout the year worse in autumn when exposed to house dust mites/animal dander/ fungal allergens.

Answer 18

artificial tears for mild symptoms Mast cell stabilisers (sodium cromoglicate) Antihistamines for symptomatic exacerbations Dual action antihistamine and mast cell stabilisers (ketotifen, olopatadine) act rapidly combined antihistamine and vasconstrictor (antazoline +xylometazoline) NSAID like diclofenac Topical steroids eefective PO Antihistamine

Answer 19

Recurrent bilateral disorder both IgE and cell mediated immune mechanisms play a role. Affects boys from 5 onwards. Remission in teenage years in 95% cases.

Answer 20

Palpebral VKC- upper tarsal conj. Significant corneal disease Limbal disease- black and asian patients Mixed VKC- both palpebral and limbal disease

Answer 21

Palpebral: early conj hyperaemia, macropapillae <1mm cobblestone/diffuse. Progression to giant papillae >1mm. Mucus deposition, decreased disease activity by mild conj injection Limbal: Gelatnous limbal conj papillae with white cellular collections (horner trantas dots). Keratopathy: SPK, Shield Ulcers, subepithelial scars, pseudogerontoxon in recurrent limbal disease, keratoconus, HSK

Answer 22

rare bilateral disease developing in adulthood peak incidence 30-50 years after a history of eczema. Asthma common in these patients. Chronic and unremitting low expectation of eventual resolution. VKC more seasonal AKC- perennial worse in winter.

Answer 23

Eosinophils less common on AKC conj scrapings compared to VKC

Answer 24

AKC more symptomatic than vkc Skin changes more prominent in AKC than VKC eczematoid, erythema, dryness, scaling, thickening, associated chronic blepharitis, keratinization, Hertoghe sign, Dennie morgaan folds, tightening of facial skin Conj involvement inferior palpebral in AKC vs Superior in VKC Keratopathy: PEEs over inferior 1/3 cornea marked, persistent ED's, plaque formation Cataract: presnile shield like anterior/ posterior subcapsular cataracts. High risk of endoph due to s. aureus

Answer 25

Same for seasonal/ perennial allergic disease + steroid ointment, antibiotics to prevent bacterial infection, NAC for mucus filaments, immunomodulators ciclosporin, calcineurin inhibitors,(tacrolimus 0.1% ointment), supratarsal steroid injections for severe palpebral disease. Systemic: PO antihistamines promote sleep/ reduce eye rubbing. Antibiotics like doxycycline, steroids, ciclosporin, tacrolimus, azathioprine. short course of high dose steroids Surgery: Superficial keratectomy remove plaques/ debride shield ulcers. Excimer laser Amniotic membrane overlay graft, botox to induce ptosis for persistent E

Answer 26

GPC occurs secondary to a variety of mechanical stimuli of tarsal conjunctiva. Encountered with CL wear.Related to mucus fishing syndrome

Answer 27

FB sensation, redness, itching, mucus production. Signs are substantial CL protein deposits, excessive CL mobility due to upper lid capture, superior tarsal hyperaemia/ papillae. Focal apical ulceration and whitish scarring, keratopathy rare, ptosis

Answer 28

Removal of CL discontinued for several weeks, replace lenses. Reduce CL wear time. Removal of other causes like exposed sutures or scleral buckle. Assess the fit of ocular prosthesis Filtering bleb partial excision/ revision. Change CL solution brand. switch to monthly then daily disposable lenses Rigid lenses reduced risk of GPC (5%) Regular use of CL protein removal tablets, regular prosthesis polishing and cleaning. Topcial mast cell stabilisers, antihistamines, topical steroids

Answer 29

group of chronic immune mucocutaneous blistering diseases. Unknown trigger leads to T2 hypersensitivity reaction. Antibodies binding to basement membrane zone (BMZ). Complement activation and recruitment of inflammatory cells with separation of epidermis from dermis leads to scarring. OCP involves the conjunctiva progressive cicatrization. Other causes are SJS/ trachoma/ drug induced/ trauma/ severe/ chronic conjunctivitis.

Answer 30

HLA DR4 HLA DQB1

Answer 31

Clinical but: biopsy of mucus membrane shows linear antibody and complement BMZ deposition Michel's transport medium when taking a specimen for direct immunofluorescence and immnoelectron microscopy

Answer 32

Foster's classification system: Stage 1= early, chronic conjunctivitis, tear dysfunction ,subepithelial fibrosis Stage 2= forniceal shortening, inferiorly Stage 3= symblepharon formation Stage 4= surface keratinization and cicatricial ankyloblepharon Mondino's classification (based on inferior forniceal depth loss) Stage 1= upto 25% Stage 2= 25-50% Stage 3= 50-75% Stage 4= greater than 75%

Answer 33

Conj: papillary conjunctivitis, diffuse hyperaemia, oedema, subtle fibrosis, fine lines of subconj fibrosis, shortening of inferior fornices, symblepharon adhesion between bulbar and palpebral conjunctiva, necrosis, flattening of plica and keratinization of caruncle, dry eye loss of goblet cells, monitor by forniceal depth. Eyelids: aberrant lashes, chronic blepharitis, keratinization of lid margin cornea: epithelial defects, infiltration and peripheral vascularization, corneal keratinization. End stage total symblepharon.

Answer 34

Systemic: Dapsone- 70% response. Contraindicated in G6PD deficiency. Sulfasalazine better tolerated sometimes Antimetabolites: azathioprine methotrexate, MMF for mild- mod disease. Cyclophosphamide for severe disease Steorids- pred 1-1.5mg/kg. effective for rapid control. Long term IOP monitoring needed. Other measures are IV IG and rituximab Topical: lubricants/ steroids/ ciclosporin/ tacrolimus/ retinoic acid to reduce keratinization/ abx/ lid hygiene Subconj MMC +/- steroid injection. CL worn with caution protect cornea

Answer 35

Reconstructive surgery for: aberrant eyelashes punctal occlusion to aid tear retention Lateral tarsorrhaphy, botox induced ptosis Entropion repair Cataract surgery Mucous membrane autografting. Amniotic membrane transplant Limbal stem cell transfer Keratoplasty high risk failure. Boston keratoprosthesis for end stage disease

Answer 36

TEN is a variant of SJS. Cell mediated delayed hypersensitivity reaction usually related to drug exposure. Medications like sulfonamides/trimethoprim, paracetamol, nevirapine. cold remedies and anticonvulsants.Infections due to mycoplasma pneumonia HSV some cancers.

Answer 37

Redness/ grittiness/ photophobia/ watering and blurring. haemorrhagic crusting of lid margins, papillary conjunctivitis, keratopathy, conj membranes/ pseudomembranes.iritis not infrequent Late signs: conj cicatrization forniceal shortening and symblepharon formation. Keratinization of conjunctiva and lid margin, eyelid cicatricial entropion + ectropion, trichasis, keratopathy scarring/ vascularization, keratinization. fibrosis of lacrimal puncta watery eye.

Answer 38

Flu like symptoms lasting upto 14 days before lesion appearance. systemic mucosal involvement nasal pain/ discharge/ pain on micturition, diarrhoea, cough, SOB, pain on eating/ drinking signs: blistering/ haemorrhagic crusting of lips. Purpuric vesicular haemorrhagic/ necrotic skin lesions involving face/ extremites/ trunk. Target lesions more classic for erythema multiforme rather than SJS/TEN

Answer 39

Removal of precipitant discontinue drugs adequate hydration/ electrolyte balance/ nutrition/ protein replacement. systemic steroids controversial. Ciclosporin/ azathioprine/ cyclophosphamide, IVIG Systemic abx- prophylaxis against skin infections Ocular: acute disease lubricants/ prevent corneal exposrure/ topical steroids iritis + conj inflammation, cycloplegia comfort, lysis of developing symblephara with glass rod, pseudomembrane peeling, treat bacterial keratitis, conj swabs for culture, IOP monitoring. Chronic disease lubrication/ punctal occlusion, topical transretinoic acid 0.01%, treat aberrant lashes, BCL, mucous membrane graft, corneal rehab STK, lamella graft, amniotic membrane graft, LSCC, keratoprosthesis

Answer 40

uncommon disease of superior limbus/ superior bulbar and tarsal conj. affects 1/ both eyes of middle aged woman 50% have abnormal thyroid function. 3% TED patients have SLK. Condition believed to be linked to blink related trauma between upper lid and superior bulbar conj. precipitated by tear insufficiency, excess lax of conj tissue.

Answer 41

FB sensation/ burning / photophobia/ mucoid discharge. similar to GPC. Conj: hyperaemia of radial band of superior bulbar conj staining with rose bengal/ limbal papillary hypertrophy. Papillary hypertrophy of tarsal plate. Petechial haemorrhages. Keratinization. Cornea: superior SPK, superior filamentary keratitis 1/3rd cases. Mild superior pannus. KCS 50%.

Answer 42

Thyroid function biopsy/impression cytology reveal keratinization of superior bulbar conjunctiva

Answer 43

Lubricants to reduce friction, NAC break down filaments, mast cell stabilisers, steroids, topical rebampide ciclosporin .05%BD, Retinoic acid retard keratinization, autologous serum 20%. Soft CL can help/ supratarsal steroid injection/ superior/inferior punctal occlusion, resection of superior limbal conj. conj ablation, treat thyroid dysfunction.

Answer 44

rare potentially sight and life threatening disorder with recurrent bilateral fibrin rich pseudomembranous lesion of wood like consistency on tarsal conj. death can occur from pulmonary involvement.

Answer 45

Histopathology: amorphous subepithelial deposits of eosinophilic material consisting of fibrin Presentation with non specific conjnctivitis in childhood 5 years median age. conj lesion noted by parents. enlarging red white lobular conj masses covered by thick yellow white mucoid discharge. corneal scarring/ vascularization/ infection/ melting.

Answer 46

surgical removal with meticulous diathermy. Discontinue antifibrinolytic drugs. After membrane removal- hourly heparin and steroids, continue until wound re-epithelialized and taper over several weeks until all inflammation resolves. IV/ topical plasminogen amniotic membrane transplant prophylactic heparin

Answer 47

self injury but occur inadvertently. damage result of mechanical trauma/ instillation of irritant from household substances like soap. Over instillation of ocular meds can be responsible.

Answer 48

inferior conj injection/ stain with rose bengal with quiet superior bulbar conj. linear corneal abrasions, persistent ED, secondary infection with candida spp, sterile ring infiltrate and hypopyon, corneal scarring

Answer 49

exclude other diagnoses close observation confrontation leads to failure to return for review psychiatric opinion may be appropriate

Answer 50

innocuous but extremely common asymptomatic elasstotic degeneration of conj stroma. Yellow white mound or aggregation of smaller mounds seen on bulbar conj adjacent to limbus more frequently located at nasal than temporal limbus. Can be calficied. Due to actinic damage

Answer 51

irritation- topical lubricants pingueculitis- short course topical steroid excision for cosmesis/ irritation. recurrence low. thermal laser ablation effective. Gentian violet maring necessary

Answer 52

triangular fibrovascular subepithelial ingrowth of degenerative bulbar conj tissue over limbus onto cornea. Excess UV exposure risk factor, runs in families. histologically similar to pingecula show elastotic degeneration in vascular subepithelial stromal collagen. pterygia enroach onto cornea invade bowman layer in contrast to pingecula which doesnt.

Answer 53

three parts to it: cap (avascular halo like zone at advancing edge), head and body. Linear iron depostion stocker line seen anterior to head of pterygium on corneal epithelium). pseudopterygium: distinguished as location far from horizontal and firm attachment t ocornea only at apex (head)

Answer 54

surgery: bare sclera simple excision results in recurrence 80%. conj autografting donor patch harvested from superior edge/ upper temporal paralimbal region. graft sutured into position 10-0 nylon. graft can be secured with TISSEEEL glue rather than sutures. Adjunctive treatment with MMC can be used. Peripheral lamellar keratoplasty for deep lesions

Conjunctiva Flashcards

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