CYSTS OF CONJUNCTIVA

The common cystic lesions of the conjunctiva are:

1. Congenital cystic lesions. These are of rare occurrence and include congenital corneoscleral cyst and cystic form of epibulbar dermoid.

2. Lymphatic cysts of conjunctiva. These are common and usually occur due to dilatation of lymph spaces in the bulbar conjunctiva. Lymphangiectasis is characterized by a row of small cysts. Rarely, lymphangioma may occur as
a single multilocular cyst.

3. Retention cysts. These occur occasionally due to

CONCRETIONS

Etiology. Concretions are formed due to accumulation
of inspissated mucus and dead epithelial cell
debris into the conjunctival depressions called loops
of Henle. They are commonly seen in elderly people
as a degenerative condition and also in patients with
scarring stage of trachoma. The name concretion is a
misnomer, as they are not calcareous deposits.

Clinical features. Concretions are seen on palpebral
conjunctiva, more commonly on upper than the lower.
They may also be seen in lower fornix. These are
yellowish white, hard looking, raised areas, varying
in size from pin point to pin head. Being hard, they
may produce foreign body sensations and lacrimation
by rubbing the corneal surface. Occasionally they
may even cause corneal abrasions.

Treatment. It consists of their removal with the help
of a hypodermic needle under topical anaesthesia.

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

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:

Grading of trachoma

McCallan's classification
McCallan in 1908, divided the clinical course of the
trachoma into following four stages:

• Stage I (Incipient trachoma or stage of infiltration). It is characterized by hyperaemia of palpebral conjunctiva and immature follicles.
• Stage II (Established trachoma or stage of florid infiltration). It is characterized by appearance of mature

TRACHOMA Symptoms & Signs

Symptoms

• In the absence of secondary infection, symptoms are minimal and include mild foreign body sensation in the eyes, occasional lacrimation, slight stickiness of the lids and scanty mucoid discharge.
• In the presence of secondary infection, typical symptoms of acute mucopurulent conjunctivitis develop.

Signs
A. Conjunctival signs
1. Congestion of upper tarsal and forniceal conjunctiva.

2. Conjunctival follicles. Follicles (Fig. 1 and Fig.2) look like boiled

what is trachoma ?

Trachoma (previously known as Egyptian ophthalmia) is a chronic keratoconjunctivitis, primarily affecting the superficial epithelium of
conjunctiva and cornea simultaneously. It is characterised by a mixed follicular and papillary response of conjunctival tissue. It is still one of the
leading causes of