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ANATOMY , PHYSIOLOGY,
SYMPTOMATOLOGY AND
CLASSIFICATION
Arterial supply;
Posterior conjunctival arteries derived from
arterial arcade of lids which is formed by
palpebral branches of nasal and lacrimal arteries
of the lids.
Anterior conjunctival arteries derived from the
anterior ciliary arteries muscular br. of
ophthalmic artery to rectus muscles.
Venous drainage;
Palpebral and Ophthalmic veins.
Lymphatic drainage
Type of discharge.
Lymphadenopathy.
DISCHARGE
Exudate plus debris plus mucus plus tears.
Serous; watery exudate in acute viral and acute
allergic conjunctivitis.
Mucoid; mucus discharge in VKC and KCS (dry
eyes).
Purulent; puss in severe acute bacterial
conjunctivitis.
Mucopurulent; puss plus mucus in mild bacterial
conjunctivitis and Chlamydial conjunctivitis.
TYPE OF CONJUNCTIVAL
REACTION
Hyperaemia: (Conjunctival injection)
Bacterial.
Sub-conjunctival Haemorrhage: Viral.
Bleeding:
Chemosis: (Oedema)
Scarring: Trachoma, cicatricial
pemphigoid, atopic conjunctivitis and
prolong use of topical drops.
Follicular reaction.
Papillary reaction.
Follicular reaction
Sub epithelial foci of hyperplastic of
lymphoid tissue with in stroma.
More prominent in fornices.
Multiple, discrete, slightly elevated,
lesions encircled by a tiny blood
vesselsmall grains of rice.
Size from 0.5 to 5 mm.
1. Viral.
2. Chlamydial.
3. Parinaud oculoglandular syndrome.
4. Hypersensitivity to topical
medications.
Follicular reaction
Papillary reaction
Hyperplastic conjunctival epithelium.
Can develop in palpebral conjunctiva (firmly attached)
and limbus.
Papilla may mask follicles.
Giant papilla (confluence)
Non-specific; (less diagnostic)
1. Chronic blephritis.
2. Allergic conjunctivitis.
3. Bacterial conjunctivitis.
4. Contact lens wears.
5. Superior limbic keratoconjunctivitis.
6. Floppy eyelid syndrome.
Pseudomembrane
Outside epithelium.
Coagulated exudate adherent to the inflammed
epithelium.
Can be easily pealed off.
Causes;
1. Severe adenoviral infection.
2. Ligneous conjunctivitis.
3. Gonococcal conjunctivitis.
4. Stevens-Johnson syndrome.
Membrane
Includes epithelium.
Infiltrate the superficial layers of conjunctival
epithelium.
Epithelium is injured if removal attempted.
Causes;
1. Diphtheria.
2. Beta-hemolytic steptococci.
Lymphadenopathy
1. Viral infection.
2. Chlamydial infection.
Indications:
Infective
Non-Infective:
Allergic
Autoimmune
Toxic
Chemical
Degenerations
Clinical
Acute
Sub-acute
Chronic
Recurrent
Age
Neonatal
Childhood
Adult
Neonatal
Chlamydial
Gonococcal
Other bacteria
Viral
Chemical
Common Bacterial
Mucopurulant
Purulant
Membraneous
CHLAMYDIAL OCULAR
INFECTIONS
Adult inclusion conjunctivitis.
Trachoma.
Viral
Adenoviral
Picarna viral
Herpes simplex
Measles
Chicken pox
Allergic
Acute allergic conjunctivitis
Vernal keratoconjunctivitis
Atopic keratoconjunctivitis
Phlactenular keratoconjunctivitis
Autoimmune
Acid burns
Alkali burns
Others
Management
Trachoma.
TRACHOMA
Etiology: Serotypes A, B, Ba & C of Chlamydia
trachomatis.
Transmission: Common fly (major Vector),
fomites, fingers.
Epidemiology:
Endemic in Africa, Asia, Middle East & Australia.
Leading cause of preventable blindness.
Worldwide 360 million people affected.
Six million people are blind from trachoma.
TRACHOMA
Risk factors:
Poverty & deprived members of community.
Poor personal & community hygiene.
Infectious pool: Preschool children of both
sexes & their care providers.
TRACHOMA
Age:
Children: Follicular & inflammatory trachoma.
Young adults: Trachomatous scarring.
Middle-aged: Trichiasis & corneal opacity.
Sex: Trichiasis & blindness 2-4 times more
common in women than men.
PRESENTATION
During childhood.
Symptoms:
FB sensation.
Redness.
Lacrimation.
Scanty mucoid discharge.
Mucopurulent discharge if secondary infection.
STAGES
I) Incipient: Characterized by:
Minute immature follicles in upper tarsal
conjunctiva.
Cytoplasmic inclusions in conjunctival
epithelium.
Stromal hyperemia & oedema.
STAGES
IIa): Follicular hypertrophy:
Large soft expressible follicles in upper tarsus,
fornix & limbus.
Punctate keratitis.
Follicular necrosis---Herberts pits.
Stromal infilteration by plasma cells &
macrophages.
STAGES
IIb): Papillary hypertrophy:
Trachoma of intense activity or chronic
trachoma with superimposed bacterial
infections.
Obscuration of follicles by papillary
hypertrophy.
STAGES
III): Cicatrizing trachoma:
Conjunctival Scarring---Arlt lines.
Pannus formation.
Lacrimal gland obstruction.
Trichiasis.
Entropion.
Symblepharon.
STAGES
IV): Healed stage:
Resolution of inflammation.
Replacement of follicles & papillae by scar
tissue.
DIAGNOSIS
Clinical diagnosis of trachoma requires the presence
of at least two of the following features:
Conjunctivitis:
Acute onset watering, redness, discomfort &
photophobia, both eyes (60%).
Signs:
Eyelids (oedematous).
Scanty discharge (watery).
EPIDEMIC
KERATOCONJUNCTIVITIS
Conjunctiva:
Follicular conjunctivitis.
Mild-moderate chemosis.
Haemorrhage.
Pseudomembrane formation.
Tender pre-auricular lymphadenopathy.
Keratitis (80%)- 7 to 10 days later in the form of
superficial punctate keratitis, subepithelial opacities
and may remain for quite a long time.
EPIDEMIC
KERATOCONJUNCTIVITIS
Hypersensitivity
reaction to specific
airborn antigens.
Frequently associated
nasal symptoms.
May be seasonal or
perennial.