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Structure
- Mucosal epithelium
- 6,000 poly's /mm3
- 14,000 lymphocyts/ mm3
- Sub-Mucosa lymphoid substantia propria
- 2,000 poly's/mm3
- 100,000 lymphocytes/mm3
- 34,000 plasma cells/mm3
- 5,000 mast cells/mm3
- Antibodies produced join with antigen forming fixed complement
which dilates blood vessels and poly's attack bacteria
T cells respond to viral allergy and make lymphokines. Lymphokines
activate cytotoxic T cells to kill virus. Helper T cells amplify
immune response.
Papilla
- 0.1-0.2 mm, red, on tarsus, vascuilar
- Pappilla release Poly's in immune response to allergy or bacteria
- Mainly in upper lid
Follicles
- 0.5-1.0 mm, yellow-white, in fornix, lymphoid
- Follicles release lymphocytes and T cells in response to virus.
- Mainly in lower lid
Discharge
- Watery Excess tears
- Cloudy Desquameted cells
- Mucoid Goblet cell production of mucous
- Purulent Poly phagocytosis
Vasodilation
- Bacterial More in fornix
- Viral Diffuse
- Allergic Diffuse with chemosis
Discharge
- Allergy Scant ropy mucous
- Bacterial Mucoprulent
- Viral Serous
- VKC Copious ropy mucous
Lymph nodes
Palpable, tender, grossly visable
- Sarcoid
- Sever EKC
- Tuberculosis
- Oculoglandular syndrome
Allergies
Atopic keratoconjunctivitis
- "MAG test"
- Pull lower lid down while patient looks upCrescent bulging indicates
allergies
- Trantas dots (White eosinophiles) at limbus
- Type IV reaction
- May form sterile ulcers
- Thick ropy discharge
- Papillary Inferior lids
- SPK
- Pannus
- Neovascularization
- Burning, itch and tear
- Uticaria, hay fever, atopic dermatitis
CL induced giant papillary conjunctivitis GPC
- Superior palpebral giant cobblestone papilla
- Type IV reaction
Contact dermatitis
Phlyctenulosis
- Hypersensitivity to bacteria and by-products (Staph most common)
- Tuberculosis, Varicella, Herpes also possible causes
- Pink-white nodule of inflammatory cells on conjunctiva that may
progress over limbus onto the cornea
- No clear interval between it and the limbus as in marginal infiltrates
- Center of nodule is gray and necrotic
- Self-limiting
- Feeder vessels
Seasonal hayfever conjunctivitis
- Type I reaction
- Chemosis, hyperemia, tearing, itch
Superior limbic keratoconjunctivitis SLK of Theodor
- Hyperthyroid version
10 year chronic
Most often middle aged females
- CL induced version
Both sexes
- Bilateral corridor pattern of bulbar hyperemia from superior rectus
to limbus
- Superior SPK
- Filaments
- No giant papilla
- Prominate limbal arcades and pannus
- May have dendrite infiltrate
- Treatment is non-preserved lubricants or cauterization with silver
nitrate
Vernal conjunctivitis
- Seasonal (Spring and summer) (More common in warm climates)
- 2:1 Males
- Usually by age 14
- Rarely over age 25
- 4-10 year duration
- Type IV reaction
- Superior palpebral giant cobblestone papilla
- SPK under lid (White flour dust of Togby)
- Burning, itching
- Thick ropy mucous
- Upper lid papilla version most common in whites.
- Limbal version with swelling and trantas dot more common in blacks.
Auto-immune reactions
Episcleritis
- Wedge of deep injection and tenderness on touch, that tends to
reoccur
- 30-60 yr. old females
- Phenylephrine blanches
- Associated with collagen diseases
- Nodular form has nodule of infiltrate
- Treatment is hot packs q3h, cold packs, decongestants, aspirin
- No uveitis
Scleritis
- Severe boring pain
- Blue or purple globe
- Probable uveitis
- Consider systemic cause
- Connective tissue disease
- Renal tuberculosis
- Venereal disease
- Arteritis
- Hypertension
- Tuberculosis
- Sarcoid
Ocular phemphigoid
- Bilateral, progressive shrinking of conjunctiva
- Entropian
- Trichiasis
- Xerosis
- Corneal opacification
- Muco-cutaneous lesions
- Most often older women
- Inferior symblepharon
- Topical steroids no help. Use systemic
Infectious disease
Bacterial conjunctivitis See
cornea section
Chlamydia conjunctivitis See cornea section
Viral Conjunctivitis See
cornea section
Irritative phenomena
Pinguecula
- Decongestant
- Bold pack
- Lubricants
- UV coating
Pterygium
- Proceeded by a iron line (Stockers line)
- 50% reoccur after surgery
- If so,it starts within weeks
- Better cure with surgery and Beta radiation
Other
Axenfeld’s loops
- Bluish pigmentation at ciliary nerves
Bitot's spot
- Keratinized spot on conjunctiva
- Avitaminousa A or dry eye
Blue sclera
- Osteogenisis imperfecta
- Ehlers-Danlos syndrome
- Marfans syndrome
- Pagets disease (Pseudoxanthoma elasticum)
- Enlarged globe
- Infantile glaucoma
- Keratoconus
- High myopia
Dermolipoma
- Firm elevated movable yellow mass at outer canthi
Hyaline plaques
- Grayish translucent spots on sclera with aging
Icteric sclera
Inclusion cyst
- Lymphatic
- Small cysts with clear or casseous contents
- Puncture, massage, antibiotics
Intraocular foreign body
Lithiasis
Lymphangiectasia
- Fluid filled cysts on bulbar conjunctiva
Nevus
- Congenital
- May not be pigmented untill puberty
Pigmentation's
Congenital melanosis oculi
- Blue sclera’s
- Darker brown peri-orbital skin, iris and fundus on one side
- If pigment over forehead to cheek called nevus of Ota
- Orientals
- Always unilateral
Acquired melanosis
- 30-40 yr. old males
- Spontaneous formation of grayish black spots on conjunctiva
- 15% develope melanoma in 30 yr.
Exogenous pigmentation's
- Argyrosis
Black lines due to silver
- Adrenaline
Brown conjunctival cysts
- Epinepherine
Black spots
- Mercury
Bluish gray lids and conjunctiva
Scleral staphyoloma
- Dark blue bulges
- Post traumatic or inflammatory
Subconjunctival hemorrhage
Tumors
Dermoids
Epithelial papilloma
- Elevated, often lobulated, movable mass
- Often found at limbus
Granuloma
- Spongy, vascular mass
- On palpebral conjunctiva mucocutaneous border
Lipodermoids
Melanoma
Nevi
Vascular
Capillary hemangioma
- In children
- May regress with age
- Associated with amblyopia?
Cavernous hemangioma
- Age 20-40
- Slow progressive exophthalmos
Kaposi’s sarcoma
- Red - blue nodules
- If found on upper body may indicate AIDS
Telangiectasia
- Irreversible dilation from prolonged irritation
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