Conjunctival disease

• Conjunctival epithelium


  • Non-keratinizing, 5 layer
• CALT


  Conjunctiva-associated lymphoid tissue, initiates & regulates immune response
• Symptoms of conjunctival inflammation

  • Lacrimation
  • Grittiness
  • Stinging
  • Burning
  • Itchiness
• Types of conjunctival discharge

  • Watery (serous exudate and tears)
  • Mucoid
  • Mucopurulent
  • Moderately purulent
  • Severe purulent
• Conjunctival reactions


  • Hyperaemia (diffuse, beefy-red, more intense away from limbus)
  • Haemorrhages
  • Chemosis (conjunctival oedema)
  • Pseudomembranes
  • True membranes
  • Infiltration
  • Subconjunctival scarring
• Follicles


  Multiple, discrete, slightly elevated lesions resembling translucent grains of rice, most prominent in the fornices
• Papillae


  Develop only in the palpebral conjunctiva and in the limbal bulbar conjunctiva where it is attached to the deeper fibrous layer
• Lymphadenopathy


  Most common cause is viral infection
• Acute bacterial conjunctivitis


  • Common, self-limiting, caused by direct eye contact with infected secretions
  • Signs: Eyelid edema, Conjunctival injection, mucopurulent discharge, Superficial punctate epithelial erosions, peripheral corneal ulcer & lymphadenopathy
• Chlamydia trachomatis


  • Exists in two principal forms: infective extracellular 'elementary body' and fragile intracellular replicating 'reticular body'
  • Signs: Watery or mucopurulent discharge, Large follicles in inferior fornix and upper tarsal conjunctiva, Superficial punctate keratitis, Peripheral subepithelial corneal infiltrates, Tender preauricular lymphadenopathy
• Trachoma


  • Leading cause of preventable irreversible blindness, related to poverty, overcrowding, and poor hygiene
  • 2 Stages: Active Trachoma, Cicatrical Trachoma
  • Management: SAFE
• Neonatal conjunctivitis


  • Most common infection in neonates, Causes: C. trachomatis, N. gonorrhoeae, herpes simplex virus
• Adenoviral conjunctivitis


  • Highly contagious, spread by contact with secretions and fomites
  • Presentation: Non-specific acute follicular conjunctivitis, Pharyngoconjunctival Fever (PCF), Epidemic keratoconjunctivitis (EKC), Chronic/relapsing adenoviral conjunctivitis
  • Signs: Eyelid edema, tender pre-auricular lymphadenopathy, Prominent conjunctival hyperemia and follicles, Severe inflammation may cause conjunctival hemorrhages, chemosis, membranes/pseudomembranes, Keratitis
• Molluscum contagiosum conjunctivitis


  • Skin infection caused by poxvirus, affects children
  • Signs: Pale, waxy, umbilicated nodule on lid margin, follicular conjunctivitis, mild mucoid discharge
• Atopy


  • Genetically determined predisposition to hypersensitivity reactions, manifests as allergic conjunctivitis, hay fever, asthma, eczema
• Acute allergic conjunctivitis


  • Acute conjunctival reaction to environmental allergen, causes acute itching, watering, severe chemosis
• Seasonal and perennial allergic conjunctivitis


  • Seasonal worse in spring/summer, perennial worse in autumn
  • Presentation: Transient acute/subacute attacks of redness, watering, itching, associated with sneezing, nasal discharge
• Vernal keratoconjunctivitis


  • Recurrent bilateral disorder, IgE- and cell-mediated mechanisms, affects boys, onset around age 5
  • Classification: Palpebral VKC, Limbal disease
• Atopic keratoconjunctivitis


  • Rare bilateral disease, develops in adulthood following history of eczema
• Giant (mechanically-induced) papillary conjunctivitis


  • Occurs secondary to mechanical stimuli, most frequently seen with contact lens wear
  • Symptoms: Foreign body sensation, redness, itching, increased mucus, blurring, loss of CL tolerance
• Mucous membrane pemphigoid


  • Chronic autoimmune mucocutaneous blistering disease, characterized by linear antibody and complement deposition at epithelial basement membranes
• Superior limbic keratoconjunctivitis


  • Uncommon chronic disease of superior limbus and conjunctiva, believed to be due to blink-related trauma and tear film insufficiency
  • Presentation: Non-specific symptoms like foreign body sensation, burning, mild photophobia, mucoid discharge, frequent blinking
• Ligneous conjunctivitis


  • Very rare, characterized by recurrent fibrin-rich pseudomembranous lesions of wood-like consistency on tarsal conjunctiva, may be due to deficiency in plasmin-mediated fibrinolysis
• Factitious conjunctivitis


  • Self-injury, either intentional or inadvertent, can cause mechanical abrasion/perforation or instillation of irritants
• Pinguecula


  • Common, innocuous, bilateral 'elastotic' degeneration of conjunctival stroma, believed to be due to actinic damage
• Pterygium


  • Triangular fibrovascular subepithelial ingrowth of degenerative bulbar conjunctival tissue over the limbus onto the cornea, histologically similar to pinguecula
• Concretions


  • Extremely common, usually associated with aging or chronic conjunctival inflammation, multiple tiny cysts containing epithelial debris in inferior tarsal and forniceal conjunctiva
• Conjunctivochalasis


  • Probably a normal ageing change, exacerbated by posterior lid margin disease, causes watering and foreign body sensation on downgaze
• Retention (epithelial inclusion) cyst

  • Fluid-filled internal cavity lined by double epithelial layer, usually a mild cosmetic blemish
• Bacterial Conjunctivitis

  Infection of the conjunctiva caused by bacteria
• Acute Bacterial Conjunctivitis


  Rapid onset bacterial infection of the conjunctiva
• Pathogenesis of Acute Bacterial Conjunctivitis

  • Direct contact with infected secretions
  • Most common isolates are H. influenzae, S. pneumoniae, S. aureus & Moraxella catarrhalis
• On waking, lids are frequently stuck together & difficult to open
• Usually bilateral; one eye affected after 1-2 days
• 60% of the cases resolve after 5 days without treatment
• Treatment plan for Acute Bacterial Conjunctivitis

  1. Topical antibiotics drops every 2 hours for 5-7 days

  2. Ointment at bedtime
• Gonococcal Keratoconjunctivitis


  Infection caused by N. gonorrhoeae capable of invading the intact corneal epithelium
• Signs of Gonococcal Keratoconjunctivitis

  • Severe eyelid edema & tenderness
  • Intense conjunctival hyperaemia
  • Chemosis
  • Profuse purulent discharge
  • Pseudomembrane formation
  • Preauricular lymphadenopathy
  • Keratitis & perforation
• Treatment for Gonococcal Keratoconjunctivitis

  1. Topical gentamicin or bacitracin hourly

  2. Systemic ceftriaxone
• Meningococcal Conjunctivitis


  Usually seen in children; can be primary or secondary