congictivitis

• • Contains the accessory lacrimal glands and the goblet cell
• Anatomy of the conjunctiva:

  • The conjunctiva is a thin mucous membrane lining the posterior surface of the lid, from which is reflected on the anterior aspect of the eyeball as far as the limbus
  • Divided into:
  • The palpebral conjunctiva: lines the under surface of the eyelids and extends to the fornix
  • The fornix conjunctiva: formed by the reflection of the palpebral conjunctiva onto the anterior portion of the eyeball
  • The bulbar conjunctiva: covers the anterior portion of the eyeball until the corneo-scleral junction (limbus)
• Subconjunctival haemorrhage:

  • Bleeding from the conjunctival vessels results in extravasation of blood into the subconjunctival tissue
  • Usually symptomless
  • Causes include trauma, acute inflammation of the conjunctiva, spontaneous rupture of a weak vessel in old people, increased intra-abdominal pressure, local manifestation of systemic vascular diseases, blood disorders, and idiopathic
  • No treatment needed as the blood takes 2-4 weeks to absorb
• • Oedema of the conjunctiva (chemosis) may occur in acute inflammation, obstruction to the orbital circulation, or abnormal blood conditions
  • Membrane and pseudomembrane formation, papillary hypertrophy, follicle formation, scar formation, corneal infiltration, and lymphadenopathy are other reactions
• Inflammation of the conjunctiva (conjunctivitis):

  • Clinical features for diagnosis include type of conjunctival discharge, type of conjunctival reaction, and lymphadenopathy
  • Type of conjunctival discharge:
  • Watery discharge: viral conjunctivitis
  • Mucoid or mucopurulent discharge: bacterial conjunctivitis
  • Purulent discharge: gonococcal infection and other virulent micro-organisms
  • Blood-stained discharge: diphtheric conjunctivitis
  • Type of conjunctival reaction:
  • Redness of the conjunctiva, most intense at the fornices and fading towards the limbus
• Trachoma:

  • Chronic inflammation of the conjunctiva and cornea caused by Chlamydia trachomatis
  • Symptoms include foreign body sensation, mucopurulent discharge, and itching
  • WHO classification includes Trachoma follicle (TF), Trachoma intense (TI), Trachoma scarring (TS), Trachoma trichiasis (TT), and Corneal opacity (CO)
  • Risk factors (5 F's): Flies, Fomites, Fingers, Faces, and Feaces
  • Treatment involves the SAFE strategy: Surgery, Antibiotic treatment, Facial cleanliness, and Environmental changes
• Vernal keratoconjunctivitis (spring catarrh):

  • Chronic recurrent allergic seasonal conjunctivitis
  • Aetiology involves exogenous allergens and physical factors
  • Symptoms include itching, photophobia, lacrimation, discolouration of the conjunctiva, and ropy discharge
  • Treatment includes dark glasses, cold compresses, local antihistamine and mast cell stabilizer, and local steroids
• Phlyctenular conjunctivitis:

  • Acute nodular affection of the conjunctiva commonly at the limbus
  • Mainly occurs in children as an allergic response to endogenous toxins
  • Symptoms include irritation, photophobia, blepharospasm, and lacrimation
  • Treatment involves local application of steroids and local antibiotics if there is a secondary bacterial infection
• Pterygium:

  • Degenerative process where a triangular fold of the conjunctiva invades the cornea
  • Symptoms include irritation when large and encroaches upon the cornea
  • Treatment includes medical treatment with NSAIDs and surgical removal for specific indications
• Pinguecula:

  • Common, innocuous, bilateral, asymptomatic condition
  • Usually seen in elderly people exposed to sunlight, dust, and wind
  • Signs include a yellowish triangular patch of bulbar conjunctiva near the limbus
  • Treatment is usually unnecessary as growth is slow