Conjunctiva

Baby picture of the day!

Papillae vs. Follicles

Papillae Think “pABillae” = Allergic &

Bacterial

Red dots of varying size (red due to central vessel)

Non-specific

Follicles Chlamydia, toxic, viral

Avascular/white nodules, filled with lymphocytes

Cysts

Benign

Fluid-filled

Concretions

Deposits of mucous secretions

Sometimes foreign body sensation

Nevi

Benign proliferation of melanocytes

Primary Acquired Melanosis (PAM)

Unilateral acquired pigmentation

Flat, indistinct margins

Conjunctival Melanosis Progression from PAM

Proliferation of melanocytes

Metastasize to the liver

Conjunctival Intraepithelial Neoplasia (CIN)

#1 conjunctival malignancy

Unilateral pre-malignant

Elevated, gelatinous mass with neovascularization

Conjunctival Squamous Cell Carcinoma

Progression from CIN

Malignant

Bacterial Conjunctivitis

Simple Children

H. influenzae or Staph

Acute redness, discharge

Gonococcal Neisseria gonorrhea

HYPERACUTE onset

Severe purulent discharge

Adenoviral Conjunctivitis

Acute non-specific conjunctivitis

Most common

Red eye, follicles, tearing

All 3 of these are very contagious!

Pharyngo-conjunctival Fever (PCF)

“Swimming pool conjunctivitis”

Pharyngitis

Acute follicular conjunctivitis

Fever

Epidemic Keratoconjunctivitis (EKC)

Most serious

Pain, corneal involvement

Molluscum Contagiosum

Associated with poor hygiene, children

DNA pox virus

Infectious

Dome-shaped, umbilicated, waxy nodules

Chronic follicular conjunctivitis

Allergy

Allergic conjunctivitis

Vernal Keratoconjunctivitis (VKC)

Atopic Keratoconjunctivitis (AKC)

Giant Papillary Conjunctivitis (GPC)

Allergic ConjunctivitisSeasonal allergic

conjunctivitis Type 1 hypersensitivity

History of allergy

Ex: pollen allergy

Perennial allergic conjunctivitis

Type 1 hypersensitivity

History of allergy

Ex: dust allergy

Vernal Keratoconjunctivitis (VKC)

Rare

Boys <10yo

Family history of atopy

Itching

Papillae on superior lid

Shield ulcer

Atopic Keratoconjunctivitis (AKC)

Young adults

History of atopy

Not seasonal

Dennie’s lines (atopy)

Inferior papillae

Giant Papillary Conjunctivitis

Associated with silicone hydrogel (SiHy) contact lens wear, mechanical trauma

Non-infectious, immune, inflammatory response

Itching, discharge, decreased wearing time

Papillae of superior lid

Chlamydia/Trachoma

Chlamydia Chlamydia is the most

common STD!

Acute follicular conjunctivitis, becomes chronic

Inferior follicles

Usually unilateral

Most common cause of ophthalmia neonatorum

Chlamydia/Trachoma

Trachoma Leading cause of

preventable blindness worldwide

Follicular conjunctivitis

Bilateral

Late-stage: Arlt Lines, tarsal conjunctival scarring, trichiasis

Phthiriasis Palpebrarum (Pediculosis Ciliaris)

Pubic lice on eyelashes

Sleeves at base of lashes

Itching

Follicular conjunctivitis, bruises from bites

Subconjunctival Hemorrhage

Causes: valsalva (coughing), medications (blood thinners), hypertension, clotting disorders

Pingueculum

Associated with UV exposure & chronic dryness

Abnormal growth of conjunctiva

Pterygium

Associated with UV exposure & chronic dryness

Abnormal growth of the conjunctiva onto the cornea, destroys Bowman’s membrane

Stocker’s line = iron deposit along leading edge of pterygium

Blocks vision & causes irregular astigmatism