NON INFECTIOUS CONJUNCTIVITIS & XEROPHTHALMIA

DR.S.VENI PRIYA

Revision Acute conjunctivitis – bacterial, viral ,

ophthalmia neonatorum Chronic – trachoma

Plan of the class Allergic conjunctivitis Immune mediated conjunctivitis – phlycten Xerophthalmia

ALLERGIC CONJUNCTIVITIS Acute allergic rhino conjunctivitis

Vernal kerato conjunctivitis

Atopic kerato conjunctivitis

Giant papillary conjunctivitis

Allergic conjunctivitis IgE mediated hypersensitivity reaction on

exposure to environmental allergens ALLERGENS : pollen ,dust, bacterial

antigens, cosmetics, animal , birds , etc

Clinical features SYMPTOMS Itching , itching, itching Mild redness Mucoid discharge ( ROPY DISCHARGE)

CLINICAL FEATURES - SIGNS CONJ- papillae Chemosis Mild redness

Complications CORNEAL INVOLVEMENT – shield ulcer ,

keratoconus DRY EYES

MANAGEMENTGENERAL MEASURES Avoid exposure to allergens -

DARK GOGGLES Cold compress Not to rub the eyes

TREATMENT To control the present attack Topical steroids - FML , loteprednal Topical antihistamine – CPM, epinastineTo prevent further attacks Mast cell stabilizers – sodium

cromoglycate, olopatidine

ACUTE ALLERGIC RHINO CONJUNCTIVITIS SEASONAL

ALLERGIC CONJUNCTIVITIS

Spring & summer

Commonest form

Tree and grass pollen

PERENNIAL ALLERGIC CONJUNCTIVITIS

↑ Autumn

Milder & less common

House dust mites, animal dander & fungal allergen

ACUTE ALLERGIC RHINO CONJUNCTIVITIS TREATMENT Mast cell stabilisers –

sodium cromoglycate q.i.d

Antihistamines

Combined therapy

Steroids – rarely indicated

VERNAL CONJUNCTIVITIS VERNAL KERATOCONJUNCTIVITIS SPRING CATARRH

Bilateral recurrent allergic conjunctivitis Ig E & cell mediated immune

mechanisms

VERNAL KERATOCONJUNCTIVITIS RISK FACTORS Boys ≥ girls , mean age – 7 yrs

Family history of atopy

Peak incidence in spring & summer

SYMPTOMS ITCHING ROPY DISCHARGE Frequent blinking

VKC – SIGNS Palpebral

Upper tarsal conjunctiva Cornea

Limbal

Mixed

VERNAL KERATOCONJUNCTIVITIS

DIFFUSE PAPILLARY HYPERTROPY OF UPPER TARSUS

MACROPAILLAE / COBBLE STONES - ≥ 1MM

PALPEBRAL FORM

VERNAL KERATOCONJUNCTIVITIS

COBBLE STONE APPEARANCE

VERNAL KERATOCONJUNCTIVITISLIMBAL FORM

Limbal papillae

White spots at

apices – Horner Trantas dots

VERNAL KERATOCONJUNCTIVITIS

KERATOPATHY Punctate epithelial

erosions

Macroerosions

Shield ulcers & plaques

VERNAL KERATOCONJUNCTIVITIS

KERATOPATHY Pseudogerontoxon –

resembles arcus senilis

Peripheral superficial vascularisation

HSV keratitis & keratoconus

VERNAL KERATOCONJUNCTIVITISTREATMENT TOPICAL Mast cell stabilisers - ↓ need for steroids

Antihistamines

Steroids – mainstay Fluromethalone 0.1 %

Cyclosporin – qid in steroid resistant cases

MUST KNOW Other names IgE mediated & cell mediated allergic Itching & ROPY DISCHARGE Papillae – COBBLE STONE APPEARANCE limbus – HORNER TRANTA’S SPOT TREATMENT – antihistamine steroid mast cell stabilizer

ATOPIC KERATOCONJUNCTIVITIS Associated with atopic dermatitis , asthma,

allergic rhinitis . Chronic, unremitting , extremely severe form

of allergic conjunctivitis → significant visual morbidity

GIANT PAPILLARY CONJUNCTIVITIS

Giant papilla- > 1 mm Soft CL wear, ocular prosthesis , exposed

sutures, filtering blebs FB sensation , redness, itching, CL intolerance TREATMENT: Remove the cause Lubricating eye drops Same as allergic conjunctivitis

ASSIGNMENT ocular side effects of using steroids (topical /

systemic) Name four ocular diseases in which steroids

are used for treatment

Immune mediated -PHYLCTENULAR CONJUNCTIVITIS Hypersensitivity reaction to endogenous

bacterial protein (tuberculosis, adenoiditis/tonsillitis)

TYPES : Conjunctival Limbal Corneal

CLINICAL FEATURES SYMPTOMS : Mild irritation Redness SIGNS : SMALL NODULE necrosis ulcer

TREATMENT Short course of topical steroids

XEROPHTHALMIA

XEROPHTHALMIA Spectrum of ocular disease ranging caused

by vitamin A deficiency. Nutritional blindness CAUSES: malnutrition, malabsorption,

chronic alcoholics, diseases which precipitate malnutrition like measles, malaria, diarrhoea , acute illness in children.

HOW ? VITAMIN A is essential for the synthesis of

retinal photo pigments & conjunctival glycoproteins.

RHODOPSIN Visual cycle delayed dark adaptation / Night Blindness

Conjunctival epithelial dysfunction ocular surface dryness

XEROPHTHALMIA

XEROPHTHALMIA XN: NIGHT BLINDNESS EARLIEST SYMPTOM responds rapidly to vitamin A therapy [ within

24-48 hours]

CONJUNCTIVAL XEROSIS X1 A : - the conjunctival epithelium undergoes

KERATANISING METAPLASIA. i.e. the normal columnar epithelium is transformed into stratified squamous epithelium. Goblet cells will be lost & keratinization occurs.

- conjunctival xerosis – starts at the temporal side

CONJUNCTIVAL XEROSIS

BITOT’S SPOT- keratin + saprophytic bacilli

[ CORYNEBACTERIUM XEROSIS] accumulate on the xerotic surface FOAMY APPEARANCE== BITOT’S SPOT

- Begin to resolve within 2-5 days & disappear by 2 weeks of treatment

-In Chronic cases, the spots will not disappear

BITOT’S SPOT

CORNEAL XEROSIS – X2 Lustreless dry appearance , in the inferior

limbus Responds within 2-5 days, disappear within 2

weeks of treatment

CORNEAL XEROSIS

X3A & X3B : KERATOMALACIA

COLLIQUATIVE NECROSIS/ LIQUAFACTIVE NECROSIS sterile corneal melting

Round or oval punched out ulcers involving the inferonasal quadrant

Perforation adherent leucoma, anterior staphyloma, phthisis bulbi

KERATOMALACIA

XEROPHTHALMIA- XS &XF XS: CORNEAL SCARRING -Nebula, macula , leucoma XF: XEROPHTHALMIC FUNDUS

/UYEMURA’S FUNDUS -Small white lesions in the retina

XEROPHTHALMIC FUNDUS

TREATMENT - MEDICAL EMERGENCY

VITAMIN A: ( 3 DOSES) 2 LAKH I.U - ORALLY OR 1 LAKH I.U – I.M 1ST DAY, 2ND DAY & WITHIN 1-4 WEEKS CHILDREN BETWEEN 6-11 MONTHS: HALF

THE DOSE CHIDREN < 6 MONTHS : QUARTER THE

DOSE

TREATMENTOCULAR LESIONS: Lubricants Broadspectrum antibiotics Cycloplegics FORTIFIED DIET

QUESTIONS VKC / SPRING CATARRAH XEROPHTHALMIA

Causes of night blindness Treatment of xerophthalmia Treatment of allergic conjunctivitis What is Bitot’s spot ? Difference between papillae & follicle.

24.2.16 - symposium Causes of Limbal nodule Acute red eye – enumerate the causes. How

to differentiate between them. Ophthalmia neonatorum Trachoma – clinical features & management

Thank u