Conjunctival Diseases

Dr. Pankaj Lamba

Specialist Ophthalmologist
Thumbay Hospital, Ajman
 Learning Outcomes : At the end of
todays session

1. Recall the basic anatomical structure of conjunctiva

2. Describe different forms of conjunctivitis
3. Discuss the clinical features of different form of conjunctival
diseases
4. Differentiate between superficial and deep congestion of eye
5. Order for relevant investigations in case of conjunctival
diseases
6. Outline a management plan for a patient with conjunctival
diseases
7. Refer patients requiring ophthalmology consultations
Pre Test 1
Pre Test 2
Revisit : Anatomy / Physiology and
Pathology
Conjunctiva
Symptoms of Conjunctival Disease
• Redness

• Itching

• Watering and Discharge

• Fleshy mass / Growth

Buzz Activity : Superficial and
Deep Congestion
 Conjunctival Responses eg of true = diptheria

Papillae Conjunctival Peseudo

Follicles / True Membranes

• Raised areas like saso • Raised area with flat tops

seen in upper tarsal
grains conjunctiva
seen in trachoma =
Concretions calcium deposits

Chemosis
edematous swelling
 Conjunctival Diseases : Overview
• Inflammations / Infections • Trauma
• Infections • Haemorrage
• Bacterial
• Viral • Tear
• Chlamydial
• Allergy
• Allergic Conjunctivitis
• Phylecten

• Degenerations • Tumors and Cysts

• Pterygium
• Nevus
• Pingencula
• Squamous cell
• Concretions
• Cysts
Inflammations of
Conjunctiva
Infections of Conjunctiva :
Conjunctivitis
• Hyperemia of Conjunctiva with
discharge

• Bacterial

• Viral

• Chlamydial

• Trauma
Case Scenario : Buzz Activity
ANSWER = CONJUNCTIVITIS

• A patient with Redness

and watery discharge
since 2 days

• Vision : Essentially
Normal

• Cornea is clear

• Recent Upper Respiratory

Uveitis = Photophobia+ ± floaters+ pain+ VA+
Conjunction

Infection Acute glaucoma = corneal oedema – fixed semi-dilated pupil –

severe pain ± vomiting – blurred VA++± preceeded by halos and
lights

Corneal ulcers
Case Scenario : Compare
May have decreased visual acuity depending on the location of
the ulcer (keratitis)

Same patient by day 10

Case Scenario : Compare
Viral Conjunctivitis : Etiology
• Adenovirus

• Herpes Virus
Treatment : Viral
Conjunctivitis
• Buzz Activity :
Treatment

• Buzz Activity : Whether

to give Topical Steroids
Case Scenario : Viral Conjunctivitis
: Diagnose and Treat
• Topical Lubricants

• Systemic Anti
Inflammatory

• Cold Compress

• Hand Hygiene and

Infection Control
Viral Kerato- Conjunctivitis : Diagnose,
Initiate treatment and Refer
• Topical Lubricants

• Systemic Anti-
Inflammatory

• Refer to
OPhthalmologist
Suspected Herpetic Kerato
Conjunctivitis
• NO Steroids

• Topical Antibiotics

• Topical Acyclovir 3% 5
times a day in case of
corneal involvement

• Systemic Anti -
inflammatory
 Case Scenario 2 :

• A 35 year old patient

with redness of eye and
severe purulent
discharge since 3 days
BACTERIAL CONJUNCTIVITIS
Investigations ?
Management : Diagnose and
Treat
• Topical Antibiotics (Drops
and Ointment) (Broad
Spectrum)
• Ofloxacin
• Monofloaxin
• 3-5 times a day
depending on severity
(may need more)
• Topical Lubricants
• Optifresh
• Systemic Anti-
inflammatory
Look out for : Danger Signal :
Refer Immediately LOOK FOR ULCERS
Case Scenario :
• A 15 day baby presents with severe yellowish white
discharge from both eyes
Neonatal conjunctivitis :
Ophthalmia Neonatorum
• First month of life
• Septic
• Chlamydia being the most common infectious agent.
• Neisseria Gonorrhea
• May acquire as they pass through the birth canal during
the birth process.
• Aseptic
• Chemical conjunctivitis induced by silver nitrate
solution, which is used for Crede prophylaxis of
infectious conjunctivitis.
Presentation :
• Severe yellowish white
discharge

• Conjunctival Injection

• May lead to corneal

involvement
Work Up
• Gram / Giemsa Stain

• Culture
Management :
• Prevention : Antenatal Care
• ? Cesarean Section
• Before reports are released
• Topical erythromycin ointment and an IV or IM third-
generation cephalosporin.
ØPrompt treatment of gonococcal conjunctivitis is
important, since this organism can penetrate an intact
corneal epithelium and rapidly cause corneal ulceration
• Modify Treatment based on lab reports

• Don’t Forget the work up of patients !

Buzz : Sequence these
• Start patient on antibiotics
• Obtain gram stain and culture samples
• Change treatment if required
Is use dexamethasone in neonatal
conjunctivitis warranted ?
 Case Scenario

• A 16 year old male

presents with recurrent
attacks of itching,
redness and watering in
both eyes
• Attacks more in springs

ALLERGIC CONJUNCTIVITIS
Allergic Conjunctivitis : Spring Catarrh
: Treatment
• Topical Steroids
• Fluorometholone 3 – 4
times a day X 14 days
• Topical Mast Cell
Stabilizers
• Sodium Cromoglicate 3
times a day X 14 days
• May need Systemic Anti
allergics
• Eg Desloratidine tab /
Syrup
Chlamydial : Trachoma
Case Scenario :
Phlyctenular keratoconjunctivitis
• Nodular inflammation
of the cornea or
conjunctiva that results
from a hypersensitivity
reaction to a foreign
antigen
• Most Common antigen
• Staphylococcus aureus
• Mycobacterium
tuberculosis
• Some intestinal
parasites
Phlyctenular keratoconjunctivitis :
treatment
• Topical Steroids
• Fluorometholone 3 – 4 times a day X 7 days

• Treating the associated blepharitis

Degenerations of
Conjunctiva
A 50 year old farmer with below
kind of growth
 Pterygium Damage to the limbus

• Fleshy growth of the conjunctiva

• Seen in outdoor workers

• ? UV light / dust exposure

Management : Conservative or
Surgery
• Conservative

• Topical Lubricants
• Topical Steroids in cases of inflammations

• Definite : Surgery
Treatment :
• Pterygium excision • Excision with Autograft
PIngencula
Trauma
Case Scenario : What is the
diagnosis
• A 6 year old patient
presented with redness
and tearing from both
eyes and multiple
blisters over mouth and
tongue and rash over
skin
• History of upper
respiratory infection 2
weeks before
Steven – Johnson Syndrome
• Stevens-Johnson syndrome is an immune-complex–
mediated hypersensitivity complex that typically
involves the skin and the mucous membranes

• Can involve eyes and cause severe conjunctivitis

and corneal involvement
 impo v much

Complication : Steven Johnson

Symblepharon
Management : Acute Phase
• Conservative
• Very Frequent Eye Lubricants
• Topical Antibiotic cover

• Prevent formation of Symblepharon

• Surgery may be required for treatment of Symblepharon

Tumors / Cysts
Post Test
 Exit Ticket
• Dexamethasone eye drops can be safely be used in
all kinds of viral Conjunctivitis

• TRUE / FALSE

• You are the pediatric resident on duty. Write a

prescription for a neonate who is suspected to be
having neonatal conjunctivitis !