CONJUNTIVA

CONJUNCTIVA : ANATOMY
DISORDERS OF CONJUNCTIVA

INFECTIOUS
NON-INFECTIOUS
DEGENERATIONS
OCULAR SURFACE DISORDERS
CONJUNCTIVITIS : INFECTIOUS

BACTERI
CHLAMYDIA
VIRUS
 CONJUNCTIVITIS

PATHOGENESIS OF SIGNS & SYMPTOMS :

RU CONJUNCTIVAL INJECTION ( HYPEREMIA )

TU CONJUNCTIVAL EDEMA (CHEMOSIS) PALPEBRAL EDEMA

DO PAIN ( itching )

KA ( increase in temperature)

FU DISCHARGE

NO VISION LOSS
 CONJUNCTIVITIS : symptoms

Non - spesific :
Lacrimation
Irritation, stinging, burning
Itching
Pain & photophobia  corneal involvement
 CONJUNCTIVITIS : sign

Conjunctival appearance :
Conjunctival injection
(hyperemia conj.)
Subconjunctival
hemorrhages
Follicular reaction
Edema
Membranes :
- Pseudomembrane

- Lymphadenopathy
 CONJUNCTIVITIS : sign

Conjunctival appearance :
Conjunctival injection
(hyperemia)
Subconjunctival
hemorrhages
Follicular reaction
Papillary reaction
Edema
Membranes :
- Pseudomembrane

- Lymphadenopathy
 CONJUNCTIVITIS : sign

Conjunctival appearance :
Conjunctival injection
(hyperemia)
Subconjunctival
hemorrhages
Follicular reaction
Papillary reaction
Edema
Membranes :
- Pseudomembrane

- Lymphadenopathy
 CONJUNCTIVITIS : sign

Conjunctival appearance :
Conjunctival injection
(hyperemia)
Subconjunctival
hemorrhages
Follicular reaction
Papillary reaction
Edema,chemosis
Membranes :
- Pseudomembrane

- Lymphadenopathy
Papillary vs Follicular reaction
 CONJUNCTIVITIS : sign

Conjunctival appearance :
Conjunctival injection
(hyperemia)
Subconjunctival
hemorrhages
Follicular reaction
Papillary reaction
Edema
Membranes :
- Pseudomembrane

- Lymphadenopathy
 CONJUNCTIVITIS : sign

Conjunctival appearance :
Conjunctival injection
(hyperemia)
Subconjunctival
hemorrhages
Follicular reaction
Papillary reaction
Edema
Membranes :
- Pseudomembrane
- Lymphadenopathy
 CONJUNCTIVITIS : sign

Conjunctival appearance :
Conjunctival injection
(hyperemia)
Subconjunctival
hemorrhages
Follicular reaction
Papillary reaction
Edema
Membranes :
- Pseudomembrane

- Lymphadenopathy
 CONJUNCTIVITIS : sign

Conjunctival appearance :
 Conjunctival injection

(hyperemia)
 Subconjunctival

hemorrhages
 Follicular reaction

 Papillary reaction

 Edema

Membranes :
- Pseudomembrane

- lymphadenopathy
 CONJUNCTIVITIS : sign

Discharge :
Watery acute viral
 acute allergic
Mucoid
Purulent
mucopurulent 
bacterial
chlamydial
 CONJUNCTIVITIS : sign

Discharge :
Watery acute viral
 acute allergic
Mucoid
Purulent
mucopurulent 
bacterial
chlamydial
CONJUNCTIVITIS : BACTERI
CONJUNCTIVITIS : BACTERI

ACUTE / SUBACUTE ONSET

OCCUR SPONTANEOUSLY OR IN EPIDEMICS

CONJUNCTIVAL INJECTION HEMORRHAGE
CONJUNCTIVAL EDEMA AND PALPEBRAL EDEMA

CHEMOSIS RIMA OCULI <<<

 CONJUNCTIVITIS : BACTERI

SLOW ONSET  CHRONIC CONJUNCTIVITIS

MILD CONJUNCTIVAL INJECTION

SCANT MUCOPURULENT DISCHARGE (most noticeable
upon awakening in the morning)
NO EYELID EDEMA
UNI or BILATERAL
 CONJUNCTIVITIS : BACTERI

HYPERACUTE ONSET (Neis. Gonorrhoea)

CONJUNCTIVAL HYPEREMIA  HEMORRHAGE

SANGUINOLENT DISCHARGE  PURULENT DIS.
(COPIUS PURULENT DISCHARGE)
MARKED PALPEBRAL EDEMA
MARKED CHEMOSIS
KERATITIS  CORNEAL ULCERATION

VISUAL ACUITY
 BACTERIAL CONJTIS : MILD

Therapy:
More
antibiotic drops : Chloramphenicol preferred
Fusidic acid
Others : ciprofloxacin, gentamycin
neomycin, tobramycin

antibiotic ointment : Chloramphenicol

Gentamycin

Provide higher concentration for

longer periods
CONJ-tis GONOBLENNORRHOEA

Therapy:
isolate the patient  contagious disease !
antibiotic drops : penicillin 30.000 unit / ml
systemic antibiotics : ceftriaxone 250 mg
KMnO4 compress
 CONJUNCTIVITIS : chlamydia

TRACHOMA

Chlamydia Trachomatis
Underprivileged populations, poor
condition

Chronic infection :
childhood : bulbar and palpebral follicles
Adult : conjunctival scarring  trichiasis
 corneal complication
bulbar scarring  Herbert’s pit
 CONJUNCTIVITIS : chlamydia

TRACHOMA

Chlamydia Trachomatis
Underprivileged populations, poor
condition

Chronic infection :

Childhood : bulbar and palpebral follicles

Adult : conjunctival scarring trichiasis
 corneal complication
bulbar scarring  Herbert’s pit
 CONJUNCTIVITIS : chlamydia
TRACHOMA

Chlamydia Trachomatis
Underprivileged populations, poor condition
Chronic infection :
childhood : bulbar and palpebral follicles adult
: conjunctival scarring  trichiasis 
corneal complication
bulbar scarring  Herbert’s pit
CONJUNCTIVITIS : chlamydia

TRACHOMA
World Health Organization grading

TF : trachomatous follicular inflammation)

> 5 follicle , upper tarsus
TI : trachomatous intense inflammation
thickening obscuring > 50% , large,deep vessels
TS : trachomatous conjunctival scarring
fibrosis in the tarsal conjunctiva
TT : trachomatous trichiasis
CO: corneal opacity
 CONJUNCTIVITIS : chlamydia

TRACHOMA
Therapy :

personal hygiene
tetracycline, 1 – 1.5 gr/d , orally –divided in 4 doses, 3 –4 weeks
doxycycline, 2 x 100 mg, 3 weeks
topical : sulfonamide, tetracycline, erythromycin
surgical correction (trichiasis)
 CONJUNCTIVITIS: viral

Pharyngo-conjunctival Fever (PCF)

Epidemic kerato-conjunctivitis (EKC)

Lid edema, follicular response, pre-auricular

adenopathy
Subconjunctival hemorrhages, chemosis
Pseudomembrane

Keratitis  80% of cases

 CONJUNCTIVITIS : viral

Pharyngo-conjunctival Fever (PCF)

Epidemic kerato-conjunctivitis (EKC)

Occur in epidemics
Highly contagious ( 2 weeks)—finger-eye contact
PCF  adenovirus types 3 and 7
EKC  adenovirus types 8 and 19
 CONJUNCTIVITIS : viral

Acute haemorrhagic conjunctivitis

Enterovirus 70
Low economic status, crowded living conditions, poor
hand-washing practices
Highly contagious but self-limiting
Palpebral follicles, sybconjunctival hemorhhage, watery
discharge
Resolves spontaneously in 7 days
No effective treatment
 Conjunctivitis : viral

Acute haemorrhagic conjunctivitis

Enterovirus 70
Incubation 8 48 hours
Low economic status, crowded living
Therapy :
conditions, poor hand-washing practices
Highly contagious but self-limiting No known treatment,
symptomatic
Palpebral follicles, sybconjunctival
hemorhhage, watery discharge
Resolves spontaneously in 7 days
No effective treatment
CONJUNCTIVITIS : NON-INFECTIOUS

Adverse reaction to topical medications

Allergic ocular disease
Hay fever conjunctivitis
Vernal keratoconjunctivitis
Atopic keratoconjunctivitis
Contact-lens induced conjunctivitis
CONJUNCTIVITIS : non-infectious

Adverse reaction to topical medications

Allergic ocular disease
Hay fever conjunctivitis
Vernal keratoconjunctivitis
Atopic keratoconjunctivitis
Contact-lens induced conjunctivitis
CONJUNCTIVITIS : non-infectious

Adverse reaction to topical

medications
Allergic ocular disease
Hay fever conjunctivitis
Vernal keratoconjunctivitis
(palpebral)
Atopic keratoconjunctivitis
Contact-lens induced
conjunctivitis
CONJUNCTIVITIS : non-infectious

Adverse reaction to topical

medications
Allergic ocular disease
 Hay fever conjunctivitis

 Vernal keratoconjunctivitis

(limbal)
 Atopic keratoconjunctivitis

 Contact-lens induced

conjunctivitis
CONJUNCTIVITIS : NON-INFECTIOUS

Adverse reaction to topical

medications
Terapi :
Allergic ocular disease
 Hay fever conjunctivitis 1. Topical steroid
 Vernal keratoconjunctivitis effective, be aware of
 Atopic keratoconjunctivitis complications
2. Sodium cromoglycate
 Contact-lens induced
Mast cells inhibition
conjunctivitis 3. Lodoxamide
Superior to cromoglycate
Mast cell inhibition
CONJUNCTIVITIS : NON-INFECTIOUS

Adverse reaction to
topical medications
Allergic ocular disease
 Hay fever

conjunctivitis
 Vernal

keratoconjunctivitis
 Atopic

keratoconjunctivitis
 Contact-lens

induced
conjunctivitis
CONJUNCTIVITIS : NON-INFECTIOUS

Adverse reaction to
topical medications Terapi :
Allergic ocular disease
 Hay fever 1. Topical steroids.
conjunctivitis Anti –inflammation
 Vernal Be aware of complications
keratoconjunctivitis 2. Sodium cromoglycate 2%
Mast cell inhibitor
 Atopic

keratoconjunctivitis
 Contact-lens

induced
conjunctivitis
CONJUNCTIVITIS : NON-INFECTIOUS

Adverse reaction to
topical medications
Allergic ocular disease
 Hay fever

conjunctivitis
 Vernal

keratoconjunctivitis
 Atopic

keratoconjunctivitis
 Contact-lens

induced
conjunctivitis
 CONJUNCTIVA : DEGENERATION

PTERYGIUM :

Triangular shaped fleshy growth

of the conjunctiva across the
cornea.
Adults, hot climate
Pterygos = wing (Greek)
CONJUNCTIVA : DEGENERATION

PTERYGIUM :

PROBLEM ?
 COSMETIC
 BLURRED VISION (IR. ASTIGM)
 SURFACE IRRITATION
 DRYNESS
CONJUNCTIVA : DEGENERATION

PSEUDO-PTERYGIUM :

PROBLEM ?
 COSMETIC
 BLURRED VISION (IR. ASTIGM)
 SURFACE IRRITATION
 DRYNESS
 PTERYGIUM

TRIANGULAR-SHAPED GROWTH
 BULBAR HYPERTROPHIED
CONJUNCTIVAL CONNECTIVE TISSUE

UNKNOWN CAUSE :

UV Radiation
Stem cell deficiency
Tear abnormalities
 PTERYGIUM : therapy

TRIANGULAR-SHAPED GROWTH
 BULBAR CONJUNCTIVAL HYPERTROPHIED
CONNECTIVE TISSUE

SURGICAL:
Bare sclera  high recurrence rate
Exterpation +Flap (amnion / conjunctiva)

RADIATION :
Beta radiation
CONJUNCTIVA : DEGENERATION

PSEUDO-PTERYGIUM

FLESHY GROWTH OF THE

CONJUNCUNTIVA ACROSS THE
CORNEA

ADULTS, HOT CLIMATE

CONJUNCTIVA : DEGENERATION

PINGUECULA :
SMALL YELLOW NODULE
ADULT
HYALINE DEGENERATIVE
ELASTIC TISSUE