Conjunctiva

Baby picture of the day!

Papillae vs. Follicles Papillae Follicles Think “pABillae” = Allergic & Bacterial Red dots of varying size (red due to central vessel) Non-specific 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) Conjunctival Melanosis Unilateral acquired pigmentation Flat, indistinct margins Progression from PAM Proliferation of melanocytes Metastasize to the liver

Conjunctival Intraepithelial Neoplasia (CIN) Conjunctival Squamous Cell Carcinoma #1 conjunctival malignancy Unilateral pre-malignant Elevated, gelatinous mass with neovascularization Progression from CIN Malignant

Bacterial Conjunctivitis Simple Gonococcal Children H. influenzae or Staph Acute redness, discharge 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 Conjunctivitis Seasonal allergic conjunctivitis Perennial allergic conjunctivitis Type 1 hypersensitivity History of allergy Ex: pollen allergy 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