PATHOLOGY OF THE

CONJUNCTIVA
 CONJUNCTIVITIS
Inflammation of the Conjunctiva
 Conjunctival sign of inflammation
Hyperemia
Injections
Papillae
Follicles
Chemosis
Membrane true, pseudo
Keratinization
Scar
Symblepharon
 HYPEREMIA
Increased redness of conjunctiva
 Conjunctival INJECTIONS
Presence of dilated blood vessels at the
periphery that fades towards the limbal area
FOLLICLES
PAPILLAE
47- Palperal spring catarrh
48- Palperal spring catarrh
49- Palperal spring catarrh
50- Palperal spring catarrh
CHEMOSIS
MEMBRANE
SCARRING
 CLASSIFICATION
By Cause
By Type of Discharges
By age of onset
By Duration
 By Cause
Bacterial
Viral
Chlamydial
Allergic
Bacterial conjunctivitis
 Hyperacute conjunctivitis
Neisseria gonorrhoeae (GC)
Lid edema, conj injection, chemosis, purulent
discharge, conjunctival memb, tender preauricular
adenopathy
Keratitis 15-40%
Conjunctival swab gram stain, C/S
 Neisseria gonorrhoeae (GC)
Treatment
copious irrigation
systemic ATB ceftriaxone, cefixime,
ciprofloxacin, ofloxacin
topical ATB ciprofloxacin,
erythromycin, gentamicin
concurrent chlamydial infection up to
33% doxycycline, azithromycin
 Neisseria meningitidis
clinical almost identical to GC
younger, more bilateral
primary or secondary from septicemia,
meningitis
 Neonatal GC conjunctivitis
2-5 days after birth
Bilateral 75%
Serosanguinouspurulent discharge
No preauricular adenopathy
Rhinitis, proctitis, disseminated
Treatment-topical + systemic (cefotaxime,
ceftriaxone)
 Viral conjunctivitis
Benign, self limited, last longer than bacterial
conjunctivitis
Almost all acute follicular conjunctivitis,
preauricular adenopathy
 Epidemic keratoconjunctivitis(EKC)
Adenovirus serotype 8,11,19,37
Redness, FB sensation, tearing, photophobia
Bilateral > 50%
Lid swelling, conjunctival injection, watery discharge,
follicles, preauricular adenopathy
Subconj hmg, membrane, pseudomembrane
Epithelial, subepithelial keratitis
 EKC
Treatment
Prevent transmission
Supportive treatment cold compress,
topical artificial tear, topical
vasoconstrictor antihistamine,topical
NSAID, topical steroid
 Pharyngoconjunctival fever
Adenovirus serotype 3,4,7
Sign & symptom same as EKC
Keratitis < EKC, mild
Pharyngitis, fever
Treatment same as EKC
Acute hemorrhagic conjunctivitis
Picornavirus enterovirus70, coxsackievirus A24
Acute follicular conjunctivitis, subconjunctival
hemorrhage
Keratitis < EKC, mild
Treatment same as EKC
 Chlamydial infection
Chlamydia trachomatis obligate intracellular
bacteria
Trachoma, adult inclusion conjunctivitis,
neonatal inclusion conjunctivitis
 Trachoma
C.trachomatis serotype A-C
Poor hygiene
Repeated infection
Chronic follicular conjunctivitis conjunctival
and corneal scar
Preventable blindness
 MacCallan classification
Stage I incipient trachoma
Acute inflammation
Immature follicles superior tarsal conj, fornices,
limbus, semilunar fold
Minimal papillae
Epi-subepithelial keratitis, early pannus at superior
cornea
 Stage II established trachoma
IIa follicles predominant
-mature follicles
-keratitis and pannus more advanced
IIb papillae predominant
-florid inflammation
-papillae at upper tarsal conj
-keratitis and pannus more advanced
-necrosis of follicles at limbus
 Stage III cicatrizing trachoma
Scar and cicatrization of conjunctiva and cornea
Limbal folliclesnecrosisscar (Herberts pit)
Upper tarsal conjunctivascar (Arlts line)
Cicatrization of lid and conjunctivatrichiasis, entropion, lid
distortion, symblepharon
Pannus - grossly visible
 Stage IV healed trachoma
Inflammation subside
Lid complication and corneal opacity visual
impairment
Diagnosis
Conjunctival swab Giemsa, Wright stain :
intracytoplasmic inclusion body
Sign & symptom : at least 2 in 4
Conjunctival follicles at UTC
Limbal follicles, Herberts pit
Typical conjunctival scar
Vascular pannus at superior cornea
 Treatment
Topical tetracycline EO, erythromycin EO
Systemic oral tetracycline, erythromycin
Surgery for lid complication
 Adult inclusion conjunctivitis
C.trachomatis serotype D-K
Oculogenital disease, sexual transmitted disease
asso with urethritis, cervicitis
Direct, indirect contact with genital secretion,
swimming pool, eye cosmetics
Subacute or acute follicular conjunctivitis
Scant mucopurulent discharge, follicles
(lower>upper), preauricular adenopathy,
keratitis, micropannus, no membrane, minimal
scar
Treatment topical +systemic ATB, sexual partner
 Neonatal inclusion conjunctivitis
C.trachomatis serotype D-K
3-14 days after birth
Mucopurulent discharge, papillae,
membrane, no preauricular adenopathy
Keratitis,pannus
Systemic infection- otitis media, rhinitis,
vaginitis, pneumonia
Conjunctival scraping-Gram, Giemsa,
Wright stain, C/S
Treatment- topical+systemic
erythromycin, cotrimoxazole
 Allergic conjunctivitis
Hay fever conjunctivitis
Type I hypersensitivity to airborne allergen,
seasonal
Bilateral, itching, irritation, tearing
Lid edema, conjunctival injection, chemosis,
papillae, mucoid discharge
Treatment avoid allergen, cold compress,
topical vasoconstrictor-antihistamine, topical
NSAID, topical steroid, topical mast cell
stabilizer, oral antihistamine
 Vernal keratoconjunctivitis
Type I and IV hypersensitivity
Male, children and young adult
Bilateral, 2 forms
Palpebral form giant papillae at UTC,
cobblestones
Limbal form opalescent nodules at superior
limbus
Horner-Trantas dots degenerated Eo and
epithelial cells
PEE, pannus, shield ulcer at superior cornea
Treatment as hay fever, 2% cyclosporin ED,
topical mucolytic, tear+CL in shield ulcer
 Atopic keratoconjunctivitis
Type I and IV hypersensitivity
Atopic dermatitis, infant and children
Blepharitis, smaller papillae at UTC and
LTC, conjunctival scar at inferior fornix
PEE at inferior, marginal corneal ulcer,
pannus, stromal opacity
Cataract PSC, ASC
Treatment same as VKC
 Contact lens induced conjunctivitis
Type IV hypersensitivity to CL, deposit on CL,
repeated mechanical trauma from CL
Soft CL > RGP CL
Redness, itching, irritation, mucoid discharge,
blurred vision
Papillae at UTC, limbal nodule, Trantas dot,
keratitis, pannus, CL decentration
Treatment resolve with off CL, improved lens
hygiene, topical mast-cell stabilizer, topical
steroid, refitting new CL(daily, disposable, RGP)
 Adverse reaction to topical
medication
Allergic reaction
Acute onset
Rare, type I
Within minutes itching, lid erythema and swelling,
chemosis, systemic anaphylaxis
Topical bacitracin, cephalosporin, penicillin,
sulfacetamide, tetracycline, anesthetics
Treatment withdraw medication, cold compress,
lubricant, topical antihistamine or steroid
 Delayed onset
Type IV
Within 24-72 hrs
Contact blepharoconjunctivitis
Lid acute eczema, erythema, scaling
Conjunctival injection, mucoid discharge, + papillae
Cornea PEE at inferior
Topical atropine, homatropine, neomycin, penicillin,
gentamicin, tobramycin, idoxuridine, trifluridine, natamycin,
antazoline, epinephrine, thimerosal, EDTA
Treatment withdraw medication, cold compress, topical
antihistamine or steroid
 Toxic reaction (much more common than allergic
reaction)
Toxic papillary conjunctivitis
Direct chemical irritation, long term use
Irritation, without itching
Conjunctival injection, papillae, mucopurulent
discharge, PEE at inferior cornea
Topical aminoglycoside, antiviral, benzalkonium
chloride
Treatment withdraw medication, preservative free
artificial tear
 Toxic follicular conjunctivitis
Long term use
Drug induced mitosis and lymphoblastic transformation of
lymphocytes by nonimmunologic
Irritation without itching
Conjunctival injection, follicles at LTC, no discharge
PEE at inferior cornea
Topical atropine, homatropine, antiviral, glaucoma
medication (epinephrine, dipivefrin, pilocarpine),
sulfonamide
Treatment withdraw medication, preservative free artificial
tear
 By Type of Discharges
Watery
Mucous
Purulent
Mucopurulent
 By Age of onset
Neonatal Conjunctivitis
Adult Conjunctivitis
 By Duration
Acute
Chronic
 Acute conjunctivitis
Staph.aureus, H.aegyptius, H.influenzae,
Strep.pneumoniae, Strep.pyogenes, P.aeruginosa,
E.coli, C.piphtheriae
Duration< 3-4 wks
Conj injection, mucopurulent discharge, lid edema, FB
sensation, tearing
Treatment- broad spectrum topical ATB
 Chronic conjunctivitis
S.aureus, Branharnella catarrharis, E.coli,
S.pyogenes, S.pneumoniae, Moraxella lacunata
>3-4 wks
Risk factor lid malposition, dry eye, chronic
dacryocystitis, poor hygiene, eye prosthesis,
topical steroid
Mild and nonspecific symptom
 conjunctivitis
Bacterial - most common in children
Viral - most common in adults
Allergic - bilateral, frequently c/o itch
 bacterial conjunctivitis

Signs:
Discharge - purulent vs mucopurulent
 Question
What type of neonatal conjunctivitis occurs
on the first day?
 Pitfalls: Adult Conjunctivitis
Adult Hyperacute Conjunctivitis
Gonococcus
Signs/symptoms of severe infection
Rapid onset
Chlamydial Conjunctivitis
Sexually active adolescents/adults
Unilateral, Follicular reaction
Chronic (>3 weeks)
Microtrak
Oral Tetracyclin
 bacterial conjunctivitis
Usually self limited
Treatment necessary?
Limits spread
Shortens course
Patient comfort
Prevents recurrence
Prevents chronic staph conjunctivitis
bacterial conjunctivitis therapy
Choice of antibiotic depends on other factors:
Polysporin
no prescription required
Polytrim
Low cost
Well tolerated
Fucithalmic
BID dosing
 Pitfalls in Treatment
Avoid
Gentamicin
Epithelial toxicity
Steroid containing solutions
Garasone
Tobradex
Blephamide
Increase IOP, Cataract
Geographic Herpes
Worsen Infection
Corneal Spread
Frequent switching of drops
 Viral Conjunctivitis
History: Infectious Contacts, URTI,
Drops/Drugs
Etiology: Adenovirus
Treatment: No specific therapy
Cool compresses, artificial tears, infectious
precautions
 Allergic Conjunctivitis

Symptoms: ITCHING
Signs: mild redness, conjunctival
chemosis, watery discharge, papillary
hypertrophy
Treatment: cold compress,
antihistamines, non-steroidal drops,
mast cell stabilizers, topical
corticosteroids
 Subconjunctival Hg

What is the appropriate management of

a large subconjunctival hemorrhage
A) Stop any anticoagulation and observe for
improvement
B) Observe. If no resolution in 1-2 weeks
refer to ophthalmology
C) Observation only
D) If large, refer to ophthalmology
Subconjunctival
Hemorrhage
28-Typical conjunctival hyperemia
29- Typical conjunctival hyperemia
 Typical conjunctival hyperemia

Characters :-
1- Vasodilatation of posterior Conjunctival vessels.
2- Bright red in color .
3- Maximum in fornices .
4- Move with movement of conjunctiva .
5- Usually associated with discharge (important)
Etiology & Different types of conjunctivitis :
1- MPC
2- PC
3- Ophtalmia neonatorum .
30- Ophthalmia neonatorum
 Ophthalmia neonatorum
Causative organism :
1- Chlamydia oculogenitalis ( 80 % ) .
2- Gonococci ( 20 % ) .
(1, 2 are most common & Acquired during passage in birth canal)
3- Other bacterial hospital infection e . staph , strept E.coli .
4- Viral infection ( Herpes genitalis ) .
5- Chemical kerato conjunctivitis e.g. silver nitrate .
Signs :
1- Marked lid edema .
2- Yellow profuse purulent discharge ( Blanorrhea ) .
3- Preauricular + submandibular lymphadenitis .
Most serious complication :
1- Secondary corneal ulcer usually central with perforation .
2- Dense corneal opacity Defective macular development (amblyopia)
Nystagmus If unilateral Squint .
3- Anterior polar cataract .
4- Endophthalmitis & panophthalmitis .
 Ophthalmia neonatorum
D.D:
1- Congenital NLD obstruction ( Congenital Dacrocystitis ).
2- ? May be Buphthalmos .
TTT:
1- prophylactic:
1- Proper antenatal care
2- Treatment of any maternal infection.
3- Anti - septic delivery .
4- Broad spectrum local eye lotion .
2- Active :
1- Hot fomentation , Boric eye lotion .
2- If Chlamydia Local acid eye lotion
Erythromycin .
3- If gonococcal Local penicillin Examine parents .
4- Cycoplegic( Atropine ) If cornea is affected .
5- Systemic Broad spectrum antibiotic ( by pediatrician ) .
Define this condition :
It is any form of conjunctivitis occurring in first 10 days after birth , it is
preventable & acquired during delivery .
31- Mucopurulent conjunctivitis
 Mucopurulent conjunctivitis
Causative organism :
1- Koch - weeks bacilli ( Heamophillus egypticus ) .
2- Staph & Strept .
3- Pneomococci .
C/O : Redness + discharge + Burning sensation + lid swelling
+ Halos around light .
Complication :
1- Secondary corneal ulcer usually central with perforation .
2- Dense corneal opacity ( scar ) :defective macular
development(Amblyopia) Nystagmus.
If unilateral squint .
3- Panophalmitis & Endophthalmitis .
4- Anterior polar cataract .
5- Chronicity .
 Mucopurulent conjunctivitis
D.D:
1-Halos around light :
1- Incipient stage of immature senile cortical cataract .
2- ACG .
3- Corneal edema .
2- Glued lashes Ulcerative blepharitis .
3- Red eye IC , CU , ACG , Scleritis , Episcleritis .
T T T:-
1- Boric acid lotion 2 - 4 % .
2- Hot fomentation & Dark glasses .
3- Local antibiotics :
1- Chlaramphenicol eye drops .
2- Tetracycline ointment at night .
3- Sulfonamide eye drops , if no pus .
4- Systemic antibiotics severe cases .
5- Atropine ointment if cornea is affected .
32- Follicular conjunctivitis
 Follicular conjunctivitis
D.D:
1- Viral infectionAdenovirusEpidemic kerotoconjunctivitia-
Pharyngeo - conjunctival fever
Herpes simplex Herpetic conjunctivitis .
2- Chlamydia oculogenitatis [ Inclusion blenorrhea[
3- Acute trachoma in foreigners.
4-Allergic , due to chronic medication [Drug induced e.g. + Atropine
+ eserine]
5- Folliculosis.
Causative organism:
1- Adenovirus . 2-Herpes S. Virus.
3- Chlamydia oculogenitatis. 4- Chronic use of drugs
TTT :
1- Decongestant. 2- Removal of the cause.
33- Acute trachomatous follicles & papillae
 Acute trachomatous follicles & papillae
Causative organism:
1- Chlamydia Trachomatous serotypes A.B.C.
C/O: Gritty sandy sensation, scanty MP discharge Redness + Heaviness of lids .
Complications:
Eye lid
1- Trichiasis [Multiple] 2- Ptosis. 3- Cicatricial entropion.
Conj.
1- Xerosis. 2- Posterior symblepharon.
3- Corneal: Ulcers & opacities.
4- Lacrimal : Fibrosis of NLD Dacrocystitis & Epiphora
TTT:
1- Boric acid lotion wash.
2- Local & systemic Sulfonamides[ sulphacetomide eye drops10-30%] .
3- Local & systemic Tetracycline [Ointment at night]
4 - In sensitive cases Chloromphenicot 0.4 % eye drops.
5- Atropine If cornea affected .
34- Acute trachomatous follicles & papillae + pannus
35- Acute trachomatous follicles & papillae + pannus
36- Acute trachomatous follicles & papillae + pannus
Acute trachomatous follicles & papillae +
pannus

See previous comment (no. 33)

37- Active trachomatous pannus
38- Active trachomatous pannus
39- Active trachomatous pannus
 Active trachomatous pannus
Define:
Sub epithelial infiltration with inflammatory cells +
vasculariztion of corneal margin, usually limited to upper
half of cornea .
D.D.:
1- Trachomatous. 2-Phlyctenutar.
3- Leprotic.
4- Degenerative [Atrophia bulbi & Absolute Glaucoma]
5- Mechanical [Rubbing lashes]
Fate:
1- Complete resolution , If B.M. is intact.
2- C. opacity, if B,M. is destroyed.
3- Kertectasia [Bulging forwards of cornea]
TTT; See previous slide
 Active trachomatous pannus
Coarse of trachomatous pannus:
1- Progressive.
2- Regressive.
3- Healed
Types of trachomotous pannus:
1- P. Tenius (Thin P)
2- P. Vasculosus (vascular P)
3- P. Annulosus (rounded P)
4- P. Carnosus (Fleshy P)
5- P. Siccus (Ory P)
41- Herberts pits (festooned cornea)
42- Scarred palpebral conjunctivitis
 Scarred palpebral conjunctivitis
Most common cause: Trachoma
Causes:
1- Trachoma.
2- Membranous conjunctivitis.
3- Chemical injures.
4- Steven - Johnson's syndrome.
Two Complications:
1- Cicatricial entropion Trichiasis.
2- Xerosis + Posterior symblepharon.
43- Membranous
conjunctivitis
 Membranous conjunctivitis
Causative org. or D.D.:
1- Diphtheria bacilli. [Diphtheria until proved other wise .
2- Viral [Severe Adenoviral infection].
3- Chemical Burns & caustics .
4- Fungal conj.
5- Severe pneumococca! Conj.
Specific complication: 1- General:
1- Toxic myocarditis , Nephropathy, Nephritis , Neuritis , Neuropathy.
2- Local:
1- Central & marginal C.Ulcer.
2- Xerosis .
3- Entropion Trichiasis
4- Symblepharon
5- Fibrosis of lacrimal duct
6- Optic neuritis + Squint d.t. cranial n. affection
Specific TTT :
l- Anti- toxic serum .
2-Penicillin systemic & local .
Investigations:
1-Culture & sensitivity from membrane 2- Blood culture .
 Membranous conjunctivitis

Specific lines of TTT:

1- Prophylactic
1- Mass immunization .
2- Isolation of patient + Notify health office .
3- Prophylactic anti serum for contacts.
4- Prophylactic antibiotic in other eye.
2-Curative
1- Complete bed rest to avoid heart failure.
2- Antitoxin serum.
3- Local & systemic penicillin.
4- Guard against symblepharon (ointment).
44- Posterior symblepharon
 Posterior symblepharon
C/O:
1- Binocular diplopia [d.t. limitation of movement ]
2- Symptoms of lagophthalmos: Redness, burning
sensation , dryness.
3- Cosmetic disfigurement.
Causes:
1- Healed Trachoma (post).
2- Chemical burns (ant).
3- Diphtheritic conj. {Membranous conj} (ant.)
4- Postoperative after ptregium surgery [after recurrent
excision] (ant.).
 Posterior symblepharon
Complications:
1- Binocular diplopia.
2- Complications of lagophthalmos.
3- Conj.:
1- Conj. Ulcers & keratinization .
2- Chronic conjunctivitis .
4- Corneal:
1- C.U. & keratinization.
2- Exposure keratitis & Vasculariztion.
TTT:
1) Management of lagophthalmos.
2) Excision of fibrous tissue with gloss rod or artificial conjunctiva!
Shell .
3) Mucous membrane graft .
4) TTT of the cause .
45- Phlyctenular keratoconjunctivitis (limbal
phlycten)
46- Phlyctenular keratoconjunctivitis
(V. important)
 Phlyctenular keratoconjunctivitis
Etiology:
Type IV Hypersensitivity reaction [cell mediated I-R.] d.t.
endogenous Toxins [Antigens]:-
e.g. T.B. focus. Tonsillitis. Septic focus of Staph
Intestinal parasites , Ulcerative Blepharitis
Associated disease: T.B. ,Tonsillitis,.....etc
Complications :
1- Recurrence, if the cause is not treated.
2- Limbal c.u.
3- Secondary infection by staph. MPC.
4- Phlyctenular pannus.
 Phlyctenular keratoconjunctivitis
D .D
1- Conj. Phlycten:
1- Pinguicuia .
2- Episcleritis [Nodular]
2- Limbal Phlycten [in slide no. 45]
3- Limbal [bulbar] spring catarrh
TTT :
l- Topical steroids.
2- TTT of septic focus [cause].
3- Local Antibiotic, for secondary infection
4- (IN Slide no. 45) Cyctoplegic [Atropine] if
Keratoconjunctivitis .
47- Palperal spring catarrh
48- Palperal spring catarrh
49- Palperal spring catarrh
50- Palperal spring catarrh
 Palperal spring catarrh
Etiology : Atopy type I hypersensitivity reaction d.t. exogenous antigen
( IgE) .
Commonest presentation: Bilateral , recurrent , seasonal attacks of
itching & ropy discharge + lacrimation .
Other clinical types you know ;
1- Bulbar S.catarrh 2- Mixed type.
Complications:
1-Corneal:
1- Keratitis superficialis vernalis of Tobgy.
2- Corneal plaques .
3- Arcus senilis like opacity (Cupid's bow) .
4- Weakness of cornea increase incidence of
Keratoconus A keratectasia .
2- Comp. of prolonged use of steroids:
1- Sec. Glaucoma
2- Complicated cataract
3- Viral infection reactivation
 Palperal spring catarrh
Safest drug used for long time for this patient: Local
decongestant .
Safest TTT:
1- Dark glasses & cold fomentations [ compresses] (Most effective).
2- Local decongestant & local Antihistaminics.
3- Local Disodium Cromoalycate .
[DON'T MENTTON STEROIDS]
TTT: 1,2,3, as before. +
4-Steroids in severe cases .
5- B-irradiation or cryo on papillae in resistant cases.
D.D. of spring catarrh:
1-Trachomo. 2- MP & PC.
D.D. of Giant papillary conjunctivitis:
1- Advanced Spring catarrh.
2- CL users.
3- Protruding stitches.
51- Bulbar spring catarrh
 Bulbar spring catarrh

See previous comment :

52- Corneal plaque in spring catarrh
 Corneal plaque in spring catarrh
Cause:
Corneal affection in spring catarrh .
Pathology:
Large micro erosions in corneal epithelium
with deposition [covered with mucin]
Resistant Corneal ulcer .
TTT :
As spring catarrh + Cycloplegic (Atropin) .
53- Argyrosis (important)
 Argyrosis (important)
Etiology:
1- Prolonged repeated painting [using]
Silver Nitrate deposits in elastic tissue
of conjunctiva [walls of B.V]
2- Occupational .
54- Subconjunctival hemorrhage
 Subconjunctival hemorrhage
Management: Self limiting condition , needs no TTT
[Reassurance of patient]
Causes:
1- Spontaneous.
2- Blunt trauma.
3- Excessive straining as whooping cough.
4- Hemorrhagic blood diseases.
5- Vascular diseases e.g. Diabetes A hypertension .
6- Conjunctivitis .
[USUALLY THE Q IS MENTION 3 CAUSES]
55- True pterygium (progressive)
 True pterygium (progressive)
Etiology :
Degenerative disease of cornea & conjunctiva d.t. exposure to UV
rays , heat , dust , irritative chemical fumes , dry sunny
environment .
C / O : Cosmetic disfigurement
Drop of vision if irregular astigmatism .
if affecting central area of cornea.
Complication:
1- Recurrence , after excision (v. Common).
2- Repeated excisions:
1- Anterior symblepharon.
2- Cornea! thinning & opacity.
TTT: Surgical removal:
1- Excision e bare scleral technique. 2- Excision e lamellar KP.
3- Tucking. 4- Rotation island operation .
Followed by Beta irradiation ( 3000-6000 rods over 3-5 days ) .
5- Conjunctival graft .
56- Bitot spots in case of xerosis
(important)
 Bitot spots in case of xerosis
Etiology: Abnormal activity of Meibomian gland [mucin
deficiency] & gas formation by proliferation of Xerosis bacilli.
Causes:
1- Trachoma.
2- Chemical burns .
3- Repeated removal of pterygium.
4- Lagophthalmos.
5- Diphtheria.
Specific test: Fluorescine break up time test
TTT :
1- Scraping [removal of Bitot spots] .
2- Artificial tears [ Methyl cellulose eye drops 1% .
3- Vit A .
57- Loss of corneal luster in cases of xerosis
 Loss of corneal luster in cases of xerosis
Causes: 1-Conjunctival scarring & fibrosis d.t.:
1- Healed Trachoma .
2- Chemical burns .
3- Diphtheria Membranous conj .
2- Lagophthalmos.
3- Vit A deficiency.
4- Sjoren's syndrome .
( 1& 2 are common causes --- 3 is less common )
Etioloay: Mucin deficiency d.t. destruction of Goblet cells .
. C/0: Burning & gritty sensation + redness + Discharge
Complications: l-Corneal ulcers, keratinization .
2- Conjunctival ulcers, kera+inizotion .
Sp. Test: Fluorescine break up time test [ Normally l5-35sec, if less
diagnostic ]
TTT of choice:
1- Artificial tears [ Methyl cellulose eye drops 17o .
2- Therapeutic CL of high water content .
3- Ointment at night + Vit A .
 NON-INFLAMMATORY
Pinguecula
Pterygium
Pseudopterygium
Nevus
Melanosis
 PINGUECULA
It is a deposition of hyaline substance in the
bulbar conjuctiva
 Pinguecula
Elastotic degeneration of collagen at bulbar
conjunctiva
Yellow-white conjunctival nodule at interpalpebral
zone
Tearing, irritation, photophobia
Treatment topical vasoconstrictor-antihistamine,
topical steroid
 Pterygium
Elastosis of collagen with subepithelial
fibrovascular tissue at bulbar conjunctiva
Interpalpebral zone
Tearing, irritation, photophobia, blurred vision
Pterygium
Pterygium
 Pterygium
Treatment
Medication as pinguecula
Surgery blurred vision, chronic inflammation,
cosmetic
 Molluscum contagiosum
DNA poxvirus
Elevated pearly umbilicated nodule near lid
margin
Chronic follicular conjunctivitis
Treatment curettage,complete excision, freezing
(self limited-months, years)