Conj

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Information about Conj
Health & Medicine

Published on April 26, 2014

Author: AbdullahLaftal

Source: slideshare.net

Conjunctival Disorders Abdulrahman Al-Amri, MD

ObjectivesObjectives  AnatomyAnatomy – ClassificationClassification – HistologyHistology  PhysiologyPhysiology  PathologyPathology – ConjunctivitisConjunctivitis – Conjunctival lesionsConjunctival lesions

CONJUNCTIVITISCONJUNCTIVITIS InfectiousInfectious BacterialBacterial ViralViral InflammatoryInflammatory AllergicAllergic –SeasonalSeasonal –Vernal Keratoconjunctivitis (VKC)Vernal Keratoconjunctivitis (VKC) NeoplasticNeoplastic

Conj. LesionsConj. Lesions  BenignBenign – PterygiumPterygium – NevusNevus  MalignantMalignant – MelanomaMelanoma – SCCSCC

AnatomyAnatomy  Mucous membraneMucous membrane 1.1. PalpebralPalpebral 2.2. FornicealForniceal 3.3. BulbarBulbar

HistologyHistology  EpitheliumEpithelium  Goblet cellsGoblet cells  StromaStroma  Lymphoid tissueLymphoid tissue

PhysiologyPhysiology Mucin layer of tear filmMucin layer of tear film

SignsSigns  HyperemiaHyperemia  Discharge:Discharge: – Watery (viral, allergic)Watery (viral, allergic) – Mucoid (vkc)Mucoid (vkc) – Purulent (gonococcal)Purulent (gonococcal)

FolliclesFollicles (Lymphoid Hyperplasia)(Lymphoid Hyperplasia)

PapillaePapillae vessles surrounded by stromalvessles surrounded by stromal edema and epith hyperplasiaedema and epith hyperplasia

PseudomembranePseudomembrane (fibrin exudation(fibrin exudation((

PathologyPathology

SymptomsSymptoms – RednessRedness – FB sensationFB sensation – DishargesDisharges – CL useCL use – VisionVision

ExaminationExamination VAVA

 HyperemiaHyperemia  Disharges &crustsDisharges &crusts  ChemosisChemosis  PapillaePapillae  Cornea…Cornea…

 BacteriologyBacteriology – Gm +ve*Gm +ve* – Gm -veGm -ve

Diagnosis Bacterial conjunctivitis

TreatmentTreatment

Indications for specialistIndications for specialist referralreferral  Change in visual acuityChange in visual acuity – Evidence of keratitisEvidence of keratitis – Anterior uveitisAnterior uveitis  Severe eye painSevere eye pain  Failure to improve or worsening ofFailure to improve or worsening of symptoms in spite of treatment.symptoms in spite of treatment.

•Purulent discharge •Hyperaemia •Chemosis • Corneal ulceration… Signs Complications

GonococcalGonococcal keratoconjunctivitiskeratoconjunctivitis

ManagementManagement

 Take scraping:Take scraping: – Gm stainingGm staining – C&S.C&S.

RxRx??

 TopicalTopical gentamycingentamycin  Ceftriaxone IVCeftriaxone IV

SymptomsSymptoms –Dischage …Dischage … –RednessRedness –Lid swellingLid swelling –FB sensationFB sensation –Vision*Vision*

SignsSigns  LymphadenopathyLymphadenopathy  Lid edema, SCHLid edema, SCH  Follicles,PseudomembraneFollicles,Pseudomembrane  KeratopathyKeratopathy

Viral conjunctivitisViral conjunctivitis

RxRx??

 Strict hygieneStrict hygiene:: – Sharing of towelsSharing of towels – Hand washingHand washing – Touching the eyeTouching the eye – Shaking handsShaking hands  Cold compressesCold compresses  LubricantsLubricants  VasocostrictorVasocostrictor – Naphazoline/pheniramine gtt(Q6hrsNaphazoline/pheniramine gtt(Q6hrs 1wk)1wk)

 SymptomsSymptoms  SignsSigns:: – Lid edemaLid edema – Lid vesiclesLid vesicles – FolliclesFollicles – KeratopathyKeratopathy – LymphLymph..

Herpes simplexHerpes simplex conjunctivitisconjunctivitis

RxRx??

RxRx Acyclovir ointAcyclovir oint

Neonatal chlamydial conjunctivitis Treatment Mucopurulent Discharges Papillary conjunctivitis* Systemic Otitis Peumonia Dx Giemsa stain IF - topical and oral antibiotics

TrachomaTrachoma  Chronic disease  Infection with serotypes A, B, and C of Chlamydia trachomatis  Common fly..poor hygiene Chronic disease Infection with serotypes A, B, and C of Chlamydia trachomatis Common fly..poor hygiene

WHO Grading  TF Follicles  TI Inflammation  TS Scarring  TT Trichiasis  CO Corneal Opacity

Herbert's pits

DxDx  Clinical*Clinical*  Immunofluorescent stainingImmunofluorescent staining

RxRx Topical:Topical: –Tetracycline ointTetracycline oint Systemic AntibioticsSystemic Antibiotics –DoxyDoxy –ErythromycinErythromycin –AzithromycinAzithromycin Art. TearsArt. Tears SurgSurg

 CommonCommon  Type IType I  SymptomsSymptoms – ItchingItching  SignsSigns – PapillaePapillae

Allergic conjunctivitisAllergic conjunctivitis

RxRx  Precipitating factorsPrecipitating factors  Cold compressesCold compresses  Topical antihistamineTopical antihistamine  Mast cell stabilizer: if chronicMast cell stabilizer: if chronic  Steroid: if severeSteroid: if severe

Vernal keratoconjunctivitis VKCVernal keratoconjunctivitis VKC  Type IType I  Cell-mediatedCell-mediated  HistoryHistory – ItchingItching – Discharge ..Discharge ..  PapillaePapillae  H-Trantas dotsH-Trantas dots

Trantas dots Trantas dots

ComplicationsComplications  CorneaCornea – scarscar  RX:RX: o Mast cell stabilizer+antihistMast cell stabilizer+antihist o SteroidSteroid o ImmunosuppresionImmunosuppresion

Conjunctival lesionsConjunctival lesions PigmentedPigmented  BenignBenign – NevusNevus  MalignantMalignant – melanomamelanoma Non-pigmNon-pigm  BenignBenign – PapillomaPapilloma – PterygiumPterygium  Malig:Malig: – SCCSCC

Conjunctival lesionsConjunctival lesions Pigmented :Pigmented :  BenignBenign – NevusNevus  melanocytesmelanocytes  MalignantMalignant – melanomamelanoma Non-pigmNon-pigm  BenignBenign – papillomapapilloma  Malig:Malig: – SCCSCC

Conjunctival lesionsConjunctival lesions Pigmented :Pigmented :  BenignBenign – NevusNevus  MalignantMalignant – melanomamelanoma Non-pigmNon-pigm  BenignBenign – papillomapapilloma  Malig:Malig: – SCCSCC

Conjunctival lesionsConjunctival lesions Pigmented :Pigmented :  BenignBenign – NevusNevus  MalignantMalignant – melanomamelanoma Non-pigmNon-pigm  BenignBenign – papillomapapilloma  Malig:Malig: – SCCSCC

ReviewReview  AnatomyAnatomy  Symptoms, SignsSymptoms, Signs CONJUNCTIVITISCONJUNCTIVITIS::  Bacterial conjBacterial conj  ViralViral  allergicallergic  Vernal keratoconjunctivitis: VKCVernal keratoconjunctivitis: VKC  Conj. lesionsConj. lesions

ExamExam ………… may be seen inmay be seen in  GlaucomaGlaucoma  TrachomaTrachoma  Herpes simplexHerpes simplex  VKCVKC  Ophthalmia neonatorumOphthalmia neonatorum Thanks

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