ASIAN MEDICAL INSTITUTE

NISHANT KUMAR.

The most common extraocular disorderEtiology:

infection of microorganism physical injuries chemical injuries allergic disorder immunological disorder nutritional deficiency

According to the cause: bacterial, chlamydial, viral, fungal, allergic conjunctivitis

According to the course: acute, subacute and chronic

Symptoms• Foreign body sensation• Scratching• Burning • Fullness around the eyes• Itching and tearing • pain and photophobia

Hyperemia Tearing Exudation Pseudoptosis Papillary hypertrophy Chemosis Follicless Pseudomembranes Ligneous conjunctivitis Granulomas Phlyctenules Preauricular lymphadenopathy

Hyperemia

Hyperemia Ciliary flush

Bacterial serous, mucous and purulent

Viral watery or serous

Allergic one or xerophthalmia

ropy filamentous

papillary hyperplasia: palpebral conjunctival epithelium

follicular formation: accumulation of lymphocyte beneath the conjunctival epithelium

pseudomembrane or membrane : the exudation rich in fibrin from palpebral conjunctiva .

Pseudomembrane: in baby and children, adenoviral, neonatal inclusion, streptococcal conj.

True membrane: diphtheritic conj.

Clinical examination Cytologic examination smear of conjunctival and scaling

smear of conjunctiva Bacteriological examination bacterial culture and drug

sensitive test Virus isolation and its antigenic

detection

Remove pathogenic cause, take local phamacotherapy as major, systemic treatment as supplement if necessary

1)instillation of eyedrops 2)instillation of ointment 3)washing of conjunctival sac 4)systemic treatment Prevention

Hyperacute purulent conjunctivitis with the strongest infectivity and large destructibilityEtiology: diplococcus gonorrhoeae

adult: auto infection children: touch infection newborn: direct infection

Clinical findings 1)incubation period: 10h-2, 3d, acute

onset 2)opthalmalgia, photophobia, tearing 3)swelling of the eyelids palpebral and bulbar hyperemia and

chemosis secretion: serous-bloody-purulent-

nong lou yan inflammatory pseudomembrane preauricular lymphadenectasis corneal ulcer and perforation

Diagnosis: clinical findings lab examination(Gram’ stain, G-

diplococcus)Treatment:

topical and systemic one is the same important Prevention

be isolated to avoid infection and epidemic

Clinical finding:acute onset(1-3days),

both eyetearing, foreign body and burning sensationconjunctival hyperemia, purulent secretion, palpebral swelling, spots of subconjunctival hemorrhage

Ill process: 2 weeks

Etiology bacterial infection:

acute-chronic or infection of bacterial with weak toxicity• non-infectious

environment factors: dust, chemical smoke or gas and irritating eye drugs• complicated from other disorders

Clinical finding:chronic onset, both eyeitching, foreign body and asthenopia or no symptomsconjunctival hyperemiamucous secretion papillary and follicle hyperplasia

Treatment: give management according to different causes

Chlamydin psittaci: Chlamydia trachomatis: antigen:ABCBa DEFGHIJK

trachoma genitourinary

system inclusion

conjunctivitis

Acute or subacute stage(1-2mon):photophobia, tearing, foreign body sensation

1)palpebral and bulbar conjunctival hyperemia

2)ropy secretion 3)papillary hyperplasia, follicles

formation 4)corneal epithelitis

be cured without scar left

Acute stage

Chronic stage: superinfections or concomitant bacterial infections1)Conjunctival hyperemia

2)ropy secretion 3)papillary hyperplasia, follicles in upper fornix and palpebral

conjunctiva conjunctival thickening scar white luster like tenden 4)corneal epithelitis

trachomatous pannus

Chronic stage

Our country Mac Callan’sI Early stage of infiltration hyperemia and thickeningearly follicle and corneal panus

I progressive stagepapillae and follicles, upper fornix is blurred,corneal panus

II active stagepapillae and follicles, corneal panus

II regressive stagescar,a little active lesion

III precicatricial stage

III complete cicatricial stagescar, no active lesion and infectivity

IV cicatricial stage

Entropion and trichiasisBlepharopatosisSymblepharon (lower fornix)Parenchymatous xerosis of conjunctivaChronic dacryocystitisCorneal pannus

1)the vessels of upper fornix and palpebral conjunctiva are blurred, congested, papillary hyperplasia or follicle formation or both

2)corneal pannus 3)scar 4)trachomatous inclusion

Diagnosis on the basis of the first plus one

of other three antigenic test

Scar corneal pannus

Topical tetracyclin, erythromycin

Systemic sulfadiazine rifampin

Operative: sequelae and complication

Acute onset, strong infectivity, may be sporadic or epidemicEtiology: adenovirus, type 8, 19, 29 and 37.

Clinical findings: 1)incubation period: 5-7d. 2)foreign body sensation, itching,

pain, photophopia and tearing 3)palpebral edema, conjunctival

hyperemia and chemosis, less and watery secretion, follicles in palpebral and fornix conjunctiva, preauricular lymphadeectasis and tenderness

4)be cured after one week exacerbate: superfial punctate

keratitis

Diagnosis: Acute folliclar cinjunctivitis superfial punctate keratitis preauricular lymphadenectasis neutrophial

Treatment: no specific drug 1)antiviral:topical(mainly) and

systemic-acyclic 2)antibiotic

Fulminant epidemic ocular infectionsEtiology:

entero-virus type 70, picornavirus

Coxsackie virus type A 24

Clinical findings: 1)incubation period: 24hr 2)ill course: self-limited, 10d or shorter 3)ophthalmagia, foreign body

sensation, photophopia and tears 4)eyelid and conjunctiva red and

swollen, watery secretion, follicular hyperplasis of palpebral conjunctiva, patchy hemorrhage on bulbar conjunctiva, preauricular lymphadenectasis

5) Transient fine punctate epithelial keratitis

Symptom:extreme itchingSign

1)palpebral type: papillary hyperplasia in the

upper palpebral conjunctiva that like oval flat cobblestone, eosinophillia in secretion

2)corneal limbal type: collid tubercles at the corneal

limbus 3)mixed type:

Treatment: 1)self-limited, no vision

affected 2)general treatment: keep away proble

sensitinogen 3)medical treatment: natrii cromoglycas corticosteroid

Immediated allergic antigen: pollen, contact lens, etc. Delayed one: various drug

Clinical findings: immediate type: dermatitis

of palpebral skin, blepharitis, mild infiltrative conjunctivitis

Lab examination: degenerative epithelial cell, few

polynuclear cells and mononuclear cells in secretionTreatment:

1)find out and get rid of sensitinogen

2)corticosteroid 3)3% boric solution 4)anti-allergic agents

Etiology: delayed reaction to protein of microorganism, mostly to mycobecterium tuberculosis and staphylococcus aureusClinical findings: herpetic tubercle may appear on the bulbar conjunctiva or limbus.

Etiology: unclear, outdoor workClinical findings:

1)hypertrophic bular conjunctiva and its subconjunctival tissue invade onto the cornea with the shape of tiangle

2)composed of head, neck, body. 3)progressive, stationary 4)differentiated with

pseudopterygiumTreatment: operation

A degenerative lesion of the bulbar conjunctiva caused by the effect of ultraviolet raysClinical findings:

a kind of white–yellow amorphous subepithelial deposition near to the limbusTreatment: no needed

Pterygium Pingueculae

Concrement on the palpebral conjunctiva

Old or those with chronic conjunctivitis

White-yellow deposit Treatment: no need be rejected

nevi Dermolipoma

angioma

Squamous Malignant cell carcinoma melanoma

Caused by vascular rupture beneath the bulbar conjunctiva or by osmotic increase of vascular wall

Treatment: 1)find out the cause 2)good explanation