1. Conjunctival Disorders
Abdulrahman Al-Amri, MD

2. ObjectivesObjectives
 AnatomyAnatomy
– ClassificationClassification
– HistologyHistology
 PhysiologyPhysiology
 PathologyPathology
– ConjunctivitisConjunctivitis
– Conjunctival lesionsConjunctival lesions

3. CONJUNCTIVITISCONJUNCTIVITIS
InfectiousInfectious
BacterialBacterial
ViralViral
InflammatoryInflammatory
AllergicAllergic
–SeasonalSeasonal
–Vernal Keratoconjunctivitis (VKC)Vernal Keratoconjunctivitis (VKC)
NeoplasticNeoplastic

4. Conj. LesionsConj. Lesions
 BenignBenign
– PterygiumPterygium
– NevusNevus
 MalignantMalignant
– MelanomaMelanoma
– SCCSCC

5. AnatomyAnatomy
 Mucous membraneMucous membrane
1.1. PalpebralPalpebral
2.2. FornicealForniceal
3.3. BulbarBulbar

6. HistologyHistology
 EpitheliumEpithelium
 Goblet cellsGoblet cells
 StromaStroma
 Lymphoid tissueLymphoid tissue

7. PhysiologyPhysiology
Mucin layer of tear filmMucin layer of tear film

9. SignsSigns
 HyperemiaHyperemia
 Discharge:Discharge:
– Watery (viral, allergic)Watery (viral, allergic)
– Mucoid (vkc)Mucoid (vkc)
– Purulent (gonococcal)Purulent (gonococcal)

10. FolliclesFollicles
(Lymphoid Hyperplasia)(Lymphoid Hyperplasia)

11. PapillaePapillae
vessles surrounded by stromalvessles surrounded by stromal
edema and epith hyperplasiaedema and epith hyperplasia

12. PseudomembranePseudomembrane
(fibrin exudation(fibrin exudation((

13. PathologyPathology

15. SymptomsSymptoms
– RednessRedness
– FB sensationFB sensation
– DishargesDisharges
– CL useCL use
– VisionVision

16. ExaminationExamination
VAVA

17.  HyperemiaHyperemia
 Disharges &crustsDisharges &crusts
 ChemosisChemosis
 PapillaePapillae
 Cornea…Cornea…

18.  BacteriologyBacteriology
– Gm +ve*Gm +ve*
– Gm -veGm -ve

19. Diagnosis
Bacterial conjunctivitis

20. TreatmentTreatment

22. Indications for specialistIndications for specialist
referralreferral
 Change in visual acuityChange in visual acuity
– Evidence of keratitisEvidence of keratitis
– Anterior uveitisAnterior uveitis
 Severe eye painSevere eye pain
 Failure to improve or worsening ofFailure to improve or worsening of
symptoms in spite of treatment.symptoms in spite of treatment.

23. •Purulent discharge
•Hyperaemia
•Chemosis
• Corneal ulceration…
Signs Complications

24. GonococcalGonococcal
keratoconjunctivitiskeratoconjunctivitis

25. ManagementManagement

26.  Take scraping:Take scraping:
– Gm stainingGm staining
– C&S.C&S.

27. RxRx??

28.  TopicalTopical
gentamycingentamycin
 Ceftriaxone IVCeftriaxone IV

29. SymptomsSymptoms
–Dischage …Dischage …
–RednessRedness
–Lid swellingLid swelling
–FB sensationFB sensation
–Vision*Vision*

30. SignsSigns
 LymphadenopathyLymphadenopathy
 Lid edema, SCHLid edema, SCH
 Follicles,PseudomembraneFollicles,Pseudomembrane
 KeratopathyKeratopathy

34. Viral conjunctivitisViral conjunctivitis

35. RxRx??

36.  Strict hygieneStrict hygiene::
– Sharing of towelsSharing of towels
– Hand washingHand washing
– Touching the eyeTouching the eye
– Shaking handsShaking hands
 Cold compressesCold compresses
 LubricantsLubricants
 VasocostrictorVasocostrictor
– Naphazoline/pheniramine gtt(Q6hrsNaphazoline/pheniramine gtt(Q6hrs
1wk)1wk)

37.  SymptomsSymptoms
 SignsSigns::
– Lid edemaLid edema
– Lid vesiclesLid vesicles
– FolliclesFollicles
– KeratopathyKeratopathy
– LymphLymph..

38. Herpes simplexHerpes simplex
conjunctivitisconjunctivitis

39. RxRx??

40. RxRx
Acyclovir ointAcyclovir oint

41. Neonatal chlamydial conjunctivitis
Treatment
Mucopurulent Discharges
Papillary conjunctivitis*
Systemic
Otitis
Peumonia
Dx
Giemsa stain
IF
- topical and oral antibiotics

43. TrachomaTrachoma
 Chronic disease
 Infection with serotypes A, B,
and C of Chlamydia trachomatis
 Common fly..poor hygiene
Chronic disease
Infection with serotypes A, B,
and C of Chlamydia trachomatis
Common fly..poor hygiene

44. WHO Grading
 TF Follicles
 TI Inflammation
 TS Scarring
 TT Trichiasis
 CO Corneal Opacity

47. Herbert's pits

48. DxDx
 Clinical*Clinical*
 Immunofluorescent stainingImmunofluorescent staining

49. RxRx
Topical:Topical:
–Tetracycline ointTetracycline oint
Systemic AntibioticsSystemic Antibiotics
–DoxyDoxy
–ErythromycinErythromycin
–AzithromycinAzithromycin
Art. TearsArt. Tears
SurgSurg

53.  CommonCommon
 Type IType I
 SymptomsSymptoms
– ItchingItching
 SignsSigns
– PapillaePapillae

54. Allergic conjunctivitisAllergic conjunctivitis

55. RxRx
 Precipitating factorsPrecipitating factors
 Cold compressesCold compresses
 Topical antihistamineTopical antihistamine
 Mast cell stabilizer: if chronicMast cell stabilizer: if chronic
 Steroid: if severeSteroid: if severe

56. Vernal keratoconjunctivitis VKCVernal keratoconjunctivitis VKC
 Type IType I
 Cell-mediatedCell-mediated
 HistoryHistory
– ItchingItching
– Discharge ..Discharge ..
 PapillaePapillae
 H-Trantas dotsH-Trantas dots

57. Trantas dots
Trantas dots

60. ComplicationsComplications
 CorneaCornea
– scarscar
 RX:RX:
o Mast cell stabilizer+antihistMast cell stabilizer+antihist
o SteroidSteroid
o ImmunosuppresionImmunosuppresion

61. Conjunctival lesionsConjunctival lesions
PigmentedPigmented
 BenignBenign
– NevusNevus
 MalignantMalignant
– melanomamelanoma
Non-pigmNon-pigm
 BenignBenign
– PapillomaPapilloma
– PterygiumPterygium
 Malig:Malig:
– SCCSCC

62. Conjunctival lesionsConjunctival lesions
Pigmented :Pigmented :
 BenignBenign
– NevusNevus
 melanocytesmelanocytes
 MalignantMalignant
– melanomamelanoma
Non-pigmNon-pigm
 BenignBenign
– papillomapapilloma
 Malig:Malig:
– SCCSCC

63. Conjunctival lesionsConjunctival lesions
Pigmented :Pigmented :
 BenignBenign
– NevusNevus
 MalignantMalignant
– melanomamelanoma
Non-pigmNon-pigm
 BenignBenign
– papillomapapilloma
 Malig:Malig:
– SCCSCC

64. Conjunctival lesionsConjunctival lesions
Pigmented :Pigmented :
 BenignBenign
– NevusNevus
 MalignantMalignant
– melanomamelanoma
Non-pigmNon-pigm
 BenignBenign
– papillomapapilloma
 Malig:Malig:
– SCCSCC

66. ReviewReview
 AnatomyAnatomy
 Symptoms, SignsSymptoms, Signs
CONJUNCTIVITISCONJUNCTIVITIS::
 Bacterial conjBacterial conj
 ViralViral
 allergicallergic
 Vernal keratoconjunctivitis: VKCVernal keratoconjunctivitis: VKC
 Conj. lesionsConj. lesions

67. ExamExam
………… may be seen inmay be seen in
 GlaucomaGlaucoma
 TrachomaTrachoma
 Herpes simplexHerpes simplex
 VKCVKC
 Ophthalmia neonatorumOphthalmia neonatorum
Thanks