Pathology of Eyelid ,

Conjunctiva And Cornea

Prepaired by hasan ali issediin
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Pathology eyelid
• Pathology of eyelids and adnexa are similar to those that occur in skin
and appendages else where in the body
• Lesions of eyelids and adnexa are of following types :
Cyst
Inflammations/infections
Most common Tumors of eyelid
Cysts

• 3 types :-
I. Inclusion cysts
II. Retention cysts
III. Developmental /dermoid cyst
Physical examination
• A superficial cyst usually presents as a smooth, painless mass in the
superotemporal quadrant, but it may also be found in the superonasal
quadrant.
• It may appear mobile or affixed to bone.
• Deeper orbital cysts may be partially palpable or non-palpabl.
Signs of Dermoid cyst

• Palpable mass
• Ptosis
• Proptosis
• Strabismus
• Pulsating proptosis with mastication
• Globe displacement
• Restriction in extraocular movements
• Inflammation
• Orbitocutaneous Fistula
Inflammation/infections
• Eyelid may be a source of a variety of specific and non-specific
infective disorders
• Some of the most frequently encountered lesions of the eyelids are
presented below :
1. Blepharitis
2. Hordeolum /stye
3. Chalazion
4. Molluscun contagiosum
Deference between stye, Hordeolum internum & chalazion.
Pathology of Conjunctiva
The conjunctiva is a mucous membrane that plays a critical role in
maintaining ocular health by forming a smooth, flexible, and
protective sac covering the pericorneal surface of the eye.
An intact conjunctiva forms a barrier to entrance of infectious
organisms and provides immune surveillance and immunoreactivity
for antigenic stimuli.
In addition, the conjunctiva secretes the mucin component of the
tear film, thus aiding in even tear distribution over the surface of the
eye.
Conjunctival vessels provide nourishment to the avascular cornea
Inflammation and infection
• A variety of infectious agents, toxins, and allergens can trigger
inflammation of the conjunctiva, or conjunctivitis.
• Conjunctivitis can be subdivided into several broad categories, such
as acute and chronic, papillary and follicular, infectious and
noninfectious, membranous and pseudomembranous,
granulomatous, and cicatrizing.
Giant papillae Follicular Conjunctivitis
Baterial Conjunctivitis
Pathology Of Cornea
• The most common corneal lesions are:
• CORNEAL FOREIGN BODY
• CORNEAL ABRASIONS.
Corneal foreign body/Corneal Abrasions
 Inflammation of the cornea
• 1- Keratitis: Epithelial, stromal or endothelial:.
• 2- Corneal ulceration:
• Most epithelial keratitis or damage develop
corneal ulcers.
• The lesion is situated at the center of the
cornea away from the vascularized limbus.
• It is accompanied by hypopion, mostly sterile,
and also seen in severe anterior Uveitis.
 Corneal ulcers. Cont.
• Predisposing factors:
• 1- widespread use of systemic and local medications like
steroids.
• 2- contact lenses wear in developed countries.
• Causes of central suppurative ulcers are: Bacteria, viral
fungal.
• Cicatrization of the cornea due to ulcer is a major cause of
blindness or impaired vision in the world. It is avoidable by
early diagnosis and prompt and appropriate treatment.
Also by prevention of predisposing factors.
Corneal scar
Treatment of corneal ulcers
• 1- Bacterial infection:
• Antibiotics ( Moxifloxacin, Ciprofloxacin, …
• 2- Fungal infections: rare disease. Antifungal
agents are used ( Vancomycin, Nystatin ).
• 3- Amebic ( trophozoites) agents:
propamudine ( antiseptics).
• Most of these drugs are used topically,
subconj. Or systemic.
 Viral keratitis
• 1- Herpes Simplex Keratitis:
• The most common cause of corneal ulcers and blindness in USA.
• Herpes infections are usually self limiting and scarring is minimal, but by
the spread use of topical corticosteroids in the avascularity of the
cornea can complicate the ulcer.
• Signs :
• Geographic ulceration: Dendritic ulcer.
• Reduced sensitivity of the cornea.
• Fluorescein staining of the ulcer.
• Treatment:
• Topical antiviral agents (Idoxuridine, Acyclovir)
• Surgical treatment: Penetrating keratoplasty is indicated in patient with
severe corneal scarring for visual rehabilitation.
 VITAMIN A DEFICIENCY
• Bitot’s spot: conj. Dry spot on the temporal
side.
• Corneal ulceration: bilateral centrally located
indolent ulcer. The cornea become soft and
necrotic ( Keratomalacia) and perforation is
common.
• Measles complications include bilateral
corneal ulceration and blindness in infants.
 VIT. A def, cont.
• Xerophthalmia: corneal and conjunctiva
epithelium changes due to vit. A deficiency.
• Causes of Vit. A def. are: dietary, impaired
absorption (diarrhea), impaired utilization
(measles).
• Treatment: Vitamin A capsules orally: 200000
IU or IM 100000IU for keratomalacia.
• Topical antibiotic ointment to prevent
secondary infections.
 Exposure Keratitis cont.

• The uncovered cornea is particularly subject

to drying during sleep and thus keratitis.
• Treatment:
• The objective of the treatment is to provide
protection and moisture for the entire cornea.
• Treatment of the underlying condition.
• Artificial tears and lubricant ointment are
useful to protect the cornea.