Disease of Conjunctiva.
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Transcript of Disease of Conjunctiva.
ASIAN MEDICAL INSTITUTE
NISHANT KUMAR.
The most common extraocular disorderEtiology:
infection of microorganism physical injuries chemical injuries allergic disorder immunological disorder nutritional deficiency
According to the cause: bacterial, chlamydial, viral, fungal, allergic conjunctivitis
According to the course: acute, subacute and chronic
Symptoms• Foreign body sensation• Scratching• Burning • Fullness around the eyes• Itching and tearing • pain and photophobia
Hyperemia Tearing Exudation Pseudoptosis Papillary hypertrophy Chemosis Follicless Pseudomembranes Ligneous conjunctivitis Granulomas Phlyctenules Preauricular lymphadenopathy
Hyperemia
Hyperemia Ciliary flush
Bacterial serous, mucous and purulent
Viral watery or serous
Allergic one or xerophthalmia
ropy filamentous
papillary hyperplasia: palpebral conjunctival epithelium
follicular formation: accumulation of lymphocyte beneath the conjunctival epithelium
pseudomembrane or membrane : the exudation rich in fibrin from palpebral conjunctiva .
Pseudomembrane: in baby and children, adenoviral, neonatal inclusion, streptococcal conj.
True membrane: diphtheritic conj.
Clinical examination Cytologic examination smear of conjunctival and scaling
smear of conjunctiva Bacteriological examination bacterial culture and drug
sensitive test Virus isolation and its antigenic
detection
Remove pathogenic cause, take local phamacotherapy as major, systemic treatment as supplement if necessary
1)instillation of eyedrops 2)instillation of ointment 3)washing of conjunctival sac 4)systemic treatment Prevention
Hyperacute purulent conjunctivitis with the strongest infectivity and large destructibilityEtiology: diplococcus gonorrhoeae
adult: auto infection children: touch infection newborn: direct infection
Clinical findings 1)incubation period: 10h-2, 3d, acute
onset 2)opthalmalgia, photophobia, tearing 3)swelling of the eyelids palpebral and bulbar hyperemia and
chemosis secretion: serous-bloody-purulent-
nong lou yan inflammatory pseudomembrane preauricular lymphadenectasis corneal ulcer and perforation
Diagnosis: clinical findings lab examination(Gram’ stain, G-
diplococcus)Treatment:
topical and systemic one is the same important Prevention
be isolated to avoid infection and epidemic
Clinical finding:acute onset(1-3days),
both eyetearing, foreign body and burning sensationconjunctival hyperemia, purulent secretion, palpebral swelling, spots of subconjunctival hemorrhage
Ill process: 2 weeks
Etiology bacterial infection:
acute-chronic or infection of bacterial with weak toxicity• non-infectious
environment factors: dust, chemical smoke or gas and irritating eye drugs• complicated from other disorders
Clinical finding:chronic onset, both eyeitching, foreign body and asthenopia or no symptomsconjunctival hyperemiamucous secretion papillary and follicle hyperplasia
Treatment: give management according to different causes
Chlamydin psittaci: Chlamydia trachomatis: antigen:ABCBa DEFGHIJK
trachoma genitourinary
system inclusion
conjunctivitis
Acute or subacute stage(1-2mon):photophobia, tearing, foreign body sensation
1)palpebral and bulbar conjunctival hyperemia
2)ropy secretion 3)papillary hyperplasia, follicles
formation 4)corneal epithelitis
be cured without scar left
Acute stage
Chronic stage: superinfections or concomitant bacterial infections1)Conjunctival hyperemia
2)ropy secretion 3)papillary hyperplasia, follicles in upper fornix and palpebral
conjunctiva conjunctival thickening scar white luster like tenden 4)corneal epithelitis
trachomatous pannus
Chronic stage
Our country Mac Callan’sI Early stage of infiltration hyperemia and thickeningearly follicle and corneal panus
I progressive stagepapillae and follicles, upper fornix is blurred,corneal panus
II active stagepapillae and follicles, corneal panus
II regressive stagescar,a little active lesion
III precicatricial stage
III complete cicatricial stagescar, no active lesion and infectivity
IV cicatricial stage
Entropion and trichiasisBlepharopatosisSymblepharon (lower fornix)Parenchymatous xerosis of conjunctivaChronic dacryocystitisCorneal pannus
1)the vessels of upper fornix and palpebral conjunctiva are blurred, congested, papillary hyperplasia or follicle formation or both
2)corneal pannus 3)scar 4)trachomatous inclusion
Diagnosis on the basis of the first plus one
of other three antigenic test
Scar corneal pannus
Topical tetracyclin, erythromycin
Systemic sulfadiazine rifampin
Operative: sequelae and complication
Acute onset, strong infectivity, may be sporadic or epidemicEtiology: adenovirus, type 8, 19, 29 and 37.
Clinical findings: 1)incubation period: 5-7d. 2)foreign body sensation, itching,
pain, photophopia and tearing 3)palpebral edema, conjunctival
hyperemia and chemosis, less and watery secretion, follicles in palpebral and fornix conjunctiva, preauricular lymphadeectasis and tenderness
4)be cured after one week exacerbate: superfial punctate
keratitis
Diagnosis: Acute folliclar cinjunctivitis superfial punctate keratitis preauricular lymphadenectasis neutrophial
Treatment: no specific drug 1)antiviral:topical(mainly) and
systemic-acyclic 2)antibiotic
Fulminant epidemic ocular infectionsEtiology:
entero-virus type 70, picornavirus
Coxsackie virus type A 24
Clinical findings: 1)incubation period: 24hr 2)ill course: self-limited, 10d or shorter 3)ophthalmagia, foreign body
sensation, photophopia and tears 4)eyelid and conjunctiva red and
swollen, watery secretion, follicular hyperplasis of palpebral conjunctiva, patchy hemorrhage on bulbar conjunctiva, preauricular lymphadenectasis
5) Transient fine punctate epithelial keratitis
Symptom:extreme itchingSign
1)palpebral type: papillary hyperplasia in the
upper palpebral conjunctiva that like oval flat cobblestone, eosinophillia in secretion
2)corneal limbal type: collid tubercles at the corneal
limbus 3)mixed type:
Treatment: 1)self-limited, no vision
affected 2)general treatment: keep away proble
sensitinogen 3)medical treatment: natrii cromoglycas corticosteroid
Immediated allergic antigen: pollen, contact lens, etc. Delayed one: various drug
Clinical findings: immediate type: dermatitis
of palpebral skin, blepharitis, mild infiltrative conjunctivitis
Lab examination: degenerative epithelial cell, few
polynuclear cells and mononuclear cells in secretionTreatment:
1)find out and get rid of sensitinogen
2)corticosteroid 3)3% boric solution 4)anti-allergic agents
Etiology: delayed reaction to protein of microorganism, mostly to mycobecterium tuberculosis and staphylococcus aureusClinical findings: herpetic tubercle may appear on the bulbar conjunctiva or limbus.
Etiology: unclear, outdoor workClinical findings:
1)hypertrophic bular conjunctiva and its subconjunctival tissue invade onto the cornea with the shape of tiangle
2)composed of head, neck, body. 3)progressive, stationary 4)differentiated with
pseudopterygiumTreatment: operation
A degenerative lesion of the bulbar conjunctiva caused by the effect of ultraviolet raysClinical findings:
a kind of white–yellow amorphous subepithelial deposition near to the limbusTreatment: no needed
Pterygium Pingueculae
Concrement on the palpebral conjunctiva
Old or those with chronic conjunctivitis
White-yellow deposit Treatment: no need be rejected
nevi Dermolipoma
angioma
Squamous Malignant cell carcinoma melanoma
Caused by vascular rupture beneath the bulbar conjunctiva or by osmotic increase of vascular wall
Treatment: 1)find out the cause 2)good explanation