Pigmented tumours of conjunctiva

1. Naevi or congenital moles. These are common pigmented lesions, usually presenting as grey gelatinous, brown or black, flat or slightly raised nodules on the bulbar conjunctiva, mostly near the limbus (Fig.1). They usually appear during early childhood and may increase in size at puberty or during pregnancy. Histologically, they resemble their cutaneous brethren. Malignant change is very rare and when occurs is indicated by sudden increase in

Discoloration of conjunctiva

Discoloration of conjunctiva( ONE OF THE SYMPTOMATIC CONDITIONS OF CONJUNCTIVA) : Normal conjunctiva is a thin transparent structure. In the bulbar region, underlying sclera and a fine network of episcleral and conjunctival vessels can be easily visualized. In the palpebral region and fornices, it looks pinkish because of underlying fibrovascular tissue.

Causes. Conjunctiva may show discoloration in various local and systemic diseases given below:
1. Red discoloration. A bright red homogeneous discoloration suggests

Xerosis of conjunctiva

Xerosis of the conjunctiva ( ONE OF THE SYMPTOMATIC CONDITIONS OF CONJUNCTIVA) is a symptomatic condition in which conjunctiva becomes dry and lustreless. Normal conjunctiva is kept moist by its own secretions, mucin from goblet cells and aqueous solution from accessory lacrimal glands. Therefore, even if the main lacrimal gland is removed, xerosis does not occur. Depending upon the etiology, conjunctival xerosis can be divided into two groups, parenchymatous and epithelial xerosis.
1. Parenchymatous xerosis. It occurs following cicatricial disorganization of the conjunctiva due to local causes which can be in the form of (i) widespread
destructive interstitial conjunctivitis as seen in

ECCHYMOSIS OF CONJUNCTIVA

Ecchymosis or subconjunctival haemorrhage (one of SYMPTOMATIC CONDITIONS OF CONJUNCTIVA) is of very common occurrence. It may vary in extent from small petechial haemorrhage to an extensive one
spreading under the whole of the bulbar conjunctiva and thus making the white sclera of the eye invisible. The condition though draws the attention of the patients immediately as an emergency but is most of the time trivial.

Etiology. Subconjunctival haemorrhage may be associated with following conditions:
1. Trauma. It is the most common cause of
subconjunctival haemorrhage. It may be in the
form of (i) local trauma to the conjunctiva including

SIMPLE HYPERAEMIA OF CONJUNCTIVA

Simple hyperaemia of conjunctiva (one of SYMPTOMATIC CONDITIONS OF CONJUNCTIVA) :  means congestion of the conjunctival vessels without being associated with any of the established diseases.

Etiology. It may be acute and transient, or recurrent
and chronic.
1. Acute transient hyperaemia. It results due to temporary irritation caused by: (i) Direct irritants such as a foreign body, misdirected cilia, concretions, dust, chemical fumes, smoke, stormy wind, bright light, extreme cold, extreme heat and simple rubbing of eyes with

pinguecula

Pinguecula is an extremely common degenerative condition of the conjunctiva. It is characterized by formation of a yellowish white patch on the bulbar conjunctiva near the limbus. This condition is termed pinguecula, because of its resemblance to fat, which means pinguis.

Etiology of pinguecula is not known exactly. It has
been considered as an age-change, occurring more
commonly in persons exposed to

GRANULOMATOUS CONJUNCTIVITIS

Granulomatous conjunctivitis "granulomatous conjunctivitis contacts" is the term used to
describe certain specific chronic inflammations of the
conjunctiva, characterised by proliferative lesions
which usually tend to remain localized to one eye and
are mostly associated with regional lymphadenitis.

Common granulomatous conjunctival inflammations
are:

• Tuberculosis of conjunctiva
• Sarcoidosis of conjunctiva
• Syphilitic conjunctivitis
• Leprotic conjunctivitis
• Conjunctivitis in tularaemia
• Ophthalmia nodosa

Parinaud's oculoglandular syndrome
It is the name given to

CONTACT DERMOCONJUNCTIVITIS

Contact dermoconjunctivitis is an allergic disorder, involving conjunctiva and
skin of lids along with surrounding area of face.

Etiology
It is in fact a delayed hypersensitivity (type IV)
response to prolonged contact with chemicals and
drugs. A few common topical ophthalmic medications

known to produce contact

Phlyctenular keratitis.

Corneal involvement may occur secondarily from extension of conjunctival
phlycten; or rarely as a primary disease. It may present in two forms: the 'ulcerative phlyctenular keratitis' or 'diffuse infiltrative keratitis'.

A. Ulcerative phlyctenular keratitis may occur in the following three forms:
1. Sacrofulous ulcer is a shallow marginal ulcer formed due to breakdown of small limbal phlycten. It differs from the catarrhal ulcer in that there is no clear space between the ulcer and the limbus and its

PHLYCTENULAR KERATOCONJUNCTIVITIS

Phlyctenular keratoconjunctivitis is a characteristic nodular affection occurring as an allergic response of the conjunctival and corneal epithelium to some endogenous allergens to which they have become sensitized. Phlyctenular conjunctivitis is of worldwide distribution. However, its incidence is higher in developing countries.
Etiology
It is believed to be a delayed hypersensitivity (Type IV-cell mediated) response to endogenous microbial proteins.
I. Causative allergens
1. Tuberculous proteins were considered, previously, as the most common cause.
2. Staphylococcus proteins are

GIANT PAPILLARY CONJUNCTIVITIS (GPC)

Giant papillary conjunctivitis is the inflammation of conjunctiva with formation of very large sized papillae.

Etiology. It is a localised allergic response to a physically rough or deposited surface (contact lens, prosthesis, left out nylon sutures). Probably it is

VERNAL KERATOCONJUNCTIVITIS

vernal keratoconjunctivitis (vkc) or spring catarrh
It is a recurrent, bilateral, interstitial, self-limiting, allergic inflammation of the conjunctiva having a periodic seasonal incidence.

Etiology
It is considered a hypersensitivity reaction to some exogenous allergen, such as grass pollens. VKC is thought to be an atopic allergic disorder in many
cases, in which IgE-mediated mechanisms play an important role. Such patients may give personal or family history of

SIMPLE ALLERGIC CONJUNCTIVITIS

Simple allergic conjunctivitis is a mild, non-specific allergic conjunctivitis
characterized by itching, hyperaemia and mild papillary response. Basically, it is an acute or sub acute urticarial reaction.

Etiology
It is seen in following forms:
1. Hay fever conjunctivitis. It is commonly associated with hay fever (allergic rhinitis). The common allergens are pollens, grass and

OPHTHALMIA NEONATORUM

Ophthalmia neonatorum is the name given to bilateral inflammation of the conjunctiva occurring in an infant, less than 30 days old. It is a preventable disease usually occurring as a result of carelessness at the time of birth. As a matter of fact any discharge or even watering from the eyes in the first week of life should arouse suspicion of ophthalmia neonatorum, as tears are not formed till then.
Etiology
Source and mode of infection
Infection may occur in three ways: before birth, during birth or after birth.

1. Before birth infection is very rare through infected liquor amnii in mothers with ruptured membrances.

2. During birth. It is the most common mode of infection from the

CHRONIC FOLLICULAR CONJUNCTIVITIS

Chronic follicular conjunctivitis is a mild type of chronic catarrhal conjunctivitis associated with follicular hyperplasia, predominantly
involving the lower lid.

Etiological types
1. Infective chronic follicular conjunctivitis is essentially a condition of 'benign folliculosis' with a superadded mild infection.
Benign folliculosis, also called 'School folliculosis', mainly affects school children. This condition usually occurs as a part of generalized
lymphoid

ACUTE FOLLICULAR CONJUNCTIVITIS

Acute follicular conjunctivitis is an acute catarrhal conjunctivitis"OR KNOWN AS ACUTE MUCOPURULENT CONJUNCTIVITIS" associated with marked follicular hyperplasia especially of the lower fornix and lower palpebral conjunctiva.

General clinical features
Symptoms are similar to acute catarrhal conjunctivitis and include: redness, watering, mild mucoid discharge, mild photophobia and feeling of

VIRAL CONJUNCTIVITIS

Most of the viral infections tend to affect the epithelium, both of the conjunctiva and cornea, so, the typical viral lesion is a 'keratoconjunctivitis'. In some viral infections, conjunctival involvement is more prominent (e.g., pharyngo-conjunctival fever), while in others cornea is more involved (e.g., herpes simplex).

Viral infections of conjunctiva include:

• Adenovirus conjunctivitis
• Herpes simplex keratoconjunctivitis
• Herpes zoster conjunctivitis
• Pox virus conjunctivitis
• Myxovirus conjunctivitis
• Paramyxovirus conjunctivitis
• ARBOR virus conjunctivitis

Clinical presentations. Acute viral conjunctivitis may
present in

ADULT INCLUSION CONJUNCTIVITIS

Adult Inclusion conjunctivitis is a type of acute follicular conjunctivitis associated with mucopurulent discharge. It usually affects the
sexually active young adults.

Etiology
Inclusion conjunctivitis is caused by serotypes D to
K of Chlamydia trachomatis. The primary source of
infection is urethritis in males and cervicitis in

Trachoma Management

Management of trachoma should involve curative as
well as control measures.

A. Treatment of active trachoma
Antibiotics for treatment of active trachoma may be
given locally or systemically, but topical treatment is
preferred because:

• It is cheaper,
• There is no risk of systemic side-effects, and

TRACHOMA Complications & Diagnosis

Complications
The only complication of trachoma is corneal ulcer
which may occur due to rubbing by concretions, or
trichiasis with superimposed bacterial infection.

Diagnosis
A. The clinical diagnosis of trachoma is made from
its typical signs; at least two sets of signs should be
present out of the following: