DISEASES OF THE CONJUNCTIVA

APPLIED ANATOMY

• The conjunctiva is a translucent mucous membrane which lines the posterior

surface of the eyelids and anterior aspect of eyeball.

• Parts of conjunctiva;
- Palpebral conjunctiva
- Bulbar conjunctiva
- Conjunctival fornix
PALBEBRAL CONJUCTIVA
CONJUNCTIVAL FORNIX
BULBAR CONJUCTIVA
DISEASE CLASSIFICATION
INFLAMMATIONS OF
CONJUNCTIVA
DEGENERATIVE CONDITIONS

• Infective conjunctivitis –
- Bacterial
• Pinguecula
- Viral
- Chlamydial • Pterygium
• Allergic conjunctivitis
• Granulomatous conjunctivitis • Concretions
SYMPTOMATIC CONDITIONS

• Hyperemia
• Xerosis
• Discoloration
• Sub conjunctival haemorrhage
• Chemosis
CONJUNCTIVITIS

• Conjunctivitis means inflammation of the conjunctiva.

• Conjunctivitis is the commonest single diagnosis in eye

clinics throughout Africa.
 ALL PATIENTS WITH CONJUNCTIVITIS HAVE
SOME SYMPTOMS AND SIGNS IN COMMON

1) Pain/Discomfort - usually described as a "foreign body sensation"

2) Redness - The conjunctiva is red and inflamed.
3) Discharge - usually sticky, but also watery, or mucous.
DISCHARGE
1) Watery discharge is composed of a serous exudate and tears and occurs
in acute viral or acute allergic conjunctivitis
2) Mucoid discharge is typical of chronic allergic conjunctivitis and dry
eye
3) Mucopurulent discharge typically occurs in chlamydial or acute
bacterial infection
4) Moderately purulent discharge occurs in acute bacterial conjunctivitis
5) Severe purulent discharge is typical of gonococcal infection
SIGNS OF CONJUNCTIVAL INFLAMMATION
(A) INJECTION; (B) HAEMORRHAGES; (C) CHEMOSIS; (D) PSEUDOMEMBRANE; (E) INFILTRATION; (F)
SUBCONJUNCTIVAL SCARRING
CONJUCTIVITIS

• It can be divided into:

1) Bacterial
2) Viral
3) Allergic
4) Chlamydial
5) Chemical
6) Granulomatous
BACTERIAL CONJUNCTIVITIS

• Commonly caused by Staphylococcus Aureus

• The patient has a gritty eye, with a purulent discharge
• The conjunctiva is red, particularly in the lower fornix, where a
purulent discharge may be visible
• The condition is self-limiting, but can be treated with topical
antibiotics, or regular face-washing
SIGNS AND SYMPTOMS
BACTERIAL CONJUNCTIVITIS - PURULENT DISCHARGE WITH MATTING OF EYELASHES
BACTERIAL CONJUNCTIVITIS. (A) EYELID EDEMA AND ERYTHEMA IN SEVERE INFECTION; (B) DIFFUSE CONJUNCTIVAL
INJECTION INVOLVING THE TARSAL AND FORNICEAL CONJUNCTIVA; (C) MUCOPURULENT DISCHARGE; (D) PROFUSE
PURULENT DISCHARGE; (E) SUPERIOR CORNEAL ULCERATION; (F) GRAM STAIN SHOWS KIDNEY-SHAPED DIPLOCOCCIC
GONOCOCCAL CONJUNCTIVITIS

• Rare but very serious form of bacterial conjunctivitis caused by

Neisseria Gonorrhea
• It usually affects very young babies, about 3-10 days old. They
become infected from their mother's genital tract during birth
• The eyelids are very swollen, and there is a profuse purulent
discharge. Within 24 hours both corneas can be totally destroyed
and the child will be permanently blind
• Gonococcal conjunctivitis can also occur in adults
• Patients with a severe purulent conjunctivitis need an immediate
swab and gram stain of their discharge

• Treatment with half-hourly antibiotic drops, and appropriate

systemic treatment for gonorrhoea.
• (OPhthalmia neonatorum) can be prevented by cleaning the eyes of
babies at birth

• Additional protection may be provided by giving a drop of an antibiotic

or disinfectant (such as Silver Nitrate or Povidine Iodine) into each eye.
VIRAL CONJUCTIVITIS

• Inflammation of the conjuctiva caused by the virus

• The two commonest viruses causing viral conjunctivitis outbreaks are:

-Adenovirus group
-Enterovirus 70 group

• Mainly occur in epidemics (schools work place)

• Transmitted by fingers, swimming pools
• The most common cause of viral conjunctivitis is adeno virus
SIGNS AND SYMPTOMS
ADENOVIRUS

• Adenovirus causes severe conjunctivitis, which may last for up to

four weeks

• Can be associated with small sub-epithelial corneal opacities, which

may take up to six months to disappear

• The patient will have follicles in the upper and lower fornices, and
the corneal opacities may be visible

• There is no specific treatment

ENTEROVIRUS70 GROUP
• Enterovirus causes acute hemorrhagic conjunctivitis

• This is a milder form of conjunctivitis, accompanied by sub-conjunctival

hemorrhages, which make the eye look worse than it really is

• There is no specific treatment

• The condition resolves spontaneously in 1-2 weeks.

PRECAUTION

• Both types of viral conjunctivitis are very infectious, and great

care must be taken to avoid transmitting the disease to other
patients or to yourself!
ALLERGIC CONJUNCTIVITIS

• This is the most common form of conjunctivitis

• vernal catarrh is the commonest form of allergic conjuctivitis

• This is a chronic allergic condition that lasts 5-7 years before spontaneously resolving

• It is common in young people, but rare in anyone over 20 years old

• It is found in cooler, higher areas of Kenya

SIGNS AND SYMPTOMS

• Itchy eyes,
• mucoid or watery discharge

• There are two types of vernal catarrh, limbal and tarsal.

• Patients with limbal vernal catarrh have large papillae around the limbus

• Those with tarsal vernal catarrh have papillae on the upper tarsal plate
• Many patients have both, but with one or other type predominating
TARSAL VERNAL DISEASE. (A) DIFFUSE PAPILLARY HYPERTROPHY; (B) MACROPAPILLAE; (C) GIANT PAPILLAE AND
MUCUS; (D) RELATIVELY INACTIVE DISEASE
LIMBAL VERNAL DISEASE. (A) SPARSE LIMBAL PAPILLAE; (B) PAPILLAE WITH HORNER–TRANTAS DOTS; (C)
EXTENSIVE PAPILLAE; (D) EXTREMELY SEVERE INVOLVEMENT
RX OF ALLERGIC CONJUNCTIVITIS

• Topical steroid drops make the eye feel much better, but the disease recurs
when the drops are stopped

• Long-term use of steroid drops may cause blindness

• Systemic steroids are more effective, but even more dangerous

• Unless there is corneal ulceration, oral steroids should be avoided

• The patient can be reassured that the disease will get better
• Immediate symptomatic relief can be obtained by washing the
eyes with clean cold water.
• Mast cell stabilizers drops
• Antihistamine drops
• Soothing agents
CHEMICAL CONJUNCTIVITIS

This is caused by exposure to an irritant chemical such as

• acids,
• tobacco
• smoke,
• snake venom, or the
• sap of certain trees- particularly Euphorbia spp.
PRESENTATION/RX

• There is usually hx of chemical entering the eye

• Patient has painful, watering, red eye
• If exposure took place within the preceding few hours, it may be
helpful to irrigate the conjunctival sac
• Antibiotic drops should be given to prevent secondary infection
THANKS