Conjunctivitis, pterygium, pinguecula

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1. Disorder of Conjunctiva Nabina Paneru

2. CONJUNCTIVITIS The conjunctiva is a thin membrane that covers the inner surface of the eyelid and the white part of the eyeball (sclera). Inflammation of the conjunctiva is called conjunctivitis, which makes the white of the eye appear red.

3. Parts of Conjunctiva

4. Glands of conjunctiva

5. Types of Conjunctivitis 1. Infective Conjunctivitis: Bacterial conjunctivitis Chlamydial conjunctivitis Viral conjunctivitis Ophthalmia neonatrum Granulomatous conjunctivitis

6. Contd. 2. Allergic conjunctivitis Simplex conjunctivitis Vernal conjunctivitis Atopic conjunctivitis (atopy: higher number of antibodies produced by body in response to antigens) Contact dermoconjunctivitis

7. Contd. 3. Cicatricial conjunctivitis Toxic epidermal necrolysis Stevens Johnson syndrome (rare, serious disorder of your skin and mucous membranes) Secondary cicatricial conjunctivitis

8. Contd. 4. Toxic conjunctivitis

9. Bacterial Conjunctivitis Inflammation of the conjunctiva caused by bacterial ( staphylococcus aureus, Chlamydia trachomatis, Moraxella, Corynebacterium diphtheriae etc.) infection. Can be sporadic and epidemic.

10. Predisposing factors Flies Hot dry climate Poor Sanitation Poor hygienic conditions Dirty habits

11. Symptoms Foreign body sensation. Mucopurulent discharge Sticking of lid during sleep/ more in the morning Colour halos Photophobia

12. Signs Conjunctival congestion

13. Contd. Chemosis

14. Contd. Petechial haemorrhage

15. Contd. Flakes of mucopus Matting of eyelashes

16. Management : Topical antibiotics Eye drops TID/QID & eye ointment HS Chloramphenical 1% Sulphacetamide 20% Ciprofloxacin 0.3% Tetracycline 1%

17. Contd. Irrigation of conjunctival sac with sterile water/saline OD/ BD. To prevent photophobia wear dark goggles. No steroid Antiinflammatory and analgesic drugs. Maintain personal hygiene.

18. 2. Viral conjunctivitis: Inflammation of conjunctiva caused by viral infection which tends to affect epithelium of both of the conjunctiva and cornea. Causative organism: Adenovirus Herpes simplex Herpes zoster Picorna virus

19. S/S: Acute onset of red eye Intense watering Discomfort & irritation Foreign body sensation Follicles Conjunctival congestion Chemosis Enlargment of pre auricular lymph node.

20. Management : Usually self limiting Antibiotic to prevent secondary infection Prevent spread to others.

21. 3. Allergic conjunctivitis: Due to allergen or hypersensitivity mostly sunlight, dust & smoke.

22. Clinical feature: Intense itching and burning sensation Hyperaemia and chemosis Foreign body sensation Photophobia Conjunctival congestion Muddy sclera

23. Treatment : Elimination of allergens if possible. Sodium chromoglycate drop 5-4 times a day. Systemic antihistamine. Topical steriod ( flourmetholone eyedrop 2-3 hrly for 7-14 days. Dark goggles to prevent photophobia. Cold compress & ice pack. Resolve after teenage

24. 4. Chemical: Chemical eye injury is due to either an acidic or alkali substance getting in the eye. Alkalis are typically worse than acidic burns. Severe burns may cause the cornea to turn white. Large volumes of irrigation (Ringer's lactate or saline solution) is the treatment of choice and should continue until the pH is 6—8. Local anaesthetic eye drops can be used to decrease the pain.

25. 5. Opthalmia neonatrum : Is an acute purulent inflammation of the conjunctiva occuring in neonatal period (within 4 wks of the birth). Causative agent: Chemical conjunctivitis, Gonococcal infection, Chlamydia, Herpes simplex

26. S/S: Pain & tenderness Mucopurulent discharge Swollen lids Conjunctival hyperaemia & chemosis Corneal opacification, ulceration & staphyloma are the complication . Management : i . Prophylaxis: Prophylaxis antenatal: Care of mother/ ANC Treatment of genital infection

27. b. Natal period Delivery to be conducted under strict aseptic technique. New baby eye should be thoroughly cleaned and dried. c. Postnatal period use of : Tetracycline ointment 1% or Erythromycin ointment 0.5% or Silver nitrate 1% solution

28. Contd. ii. Curative: Irrigation of conjunctiva with sterile saline. Topical antibiotic eye drop/ ointment. Systemic therapy. Steroid use is contraindicated.

29. B. PTERYGIUM/ SURFER’S EYE A  pterygium  is a triangular-shaped growth of fleshy tissue on the white of the eye that eventually extends over the cornea. This growth may remain small or grow large enough to interfere with vision. A pterygium can often develop from a pinguecula . A pterygium commonly grows from the nasal side of the sclera .

30. Causes : Most experts believe that significant risk factors include: Prolonged exposure to ultraviolet light Dry eye Irritants such as dust and wind. Symptoms : Burning, tearing Gritty feeling Itching Blurred vision

31. Treatment: Mild symptoms :doesn't require treatment. If a temporary worsening of the inflamed condition causes redness or irritation, it can be treated with: Lubricating eyedrops or ointments, such as Blink or Refresh drops. Occasional use of vasoconstrictor eyedrops .

32. Contd. Short course of steroid eyedrops . If lesion cause persistent discomfort or vision interference, surgical treatment is required. In this procedure, the pterygium is removed and the own client conjunctiva or amniotic membrane is glued or stitched onto the affected area.

33. C. PINGUECULA A  pinguecula  (above) is a yellowish patch or bump on the conjunctiva, near the cornea. It most often appears on the side of the eye closest to the nose.

34. S/S: Triangular fold of red fleshy growth. Foreign body sensation, Pingueculae become swollen and inflamed. Irritation Red eye Management : Surgical excision and graft.