Transcript Clinical findings

Disease of the
conjunctiva
China Medical University NO.4
Affiliated hospital Ophthalmology;
Ophthalmology hospital of China
Medical University
Conjunctivitis
The most common extraocular
disorder
Etiology:
infection of microorganism
physical injuries
chemical injuries
allergic disorder
immunological disorder
nutritional deficiency
Conjunctivitis Classification
According to the cause: bacterial,
chlamydial, viral, fungal, allergic
conjunctivitis
According to the course: acute,
subacute and chronic
Conjunctivitis Clinical manifestation
Symptoms
– Foreign body sensation
– Scratching
– Burning
– Fullness around the eyes
– Itching and tearing
– pain and photophobia
Signs of conjunctivitis
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Hyperemia
Tearing
Exudation
Pseudoptosis
Papillary hypertrophy
Chemosis
Follicless
Pseudomembranes
Ligneous conjunctivitis
Granulomas
Phlyctenules
Preauricular lymphadenopathy
Physical sign
• Hyperemia
• Hyperemia
Ciliary flush
Secretion
• Bacterial
and purulent
serous, mucous
• Viral
watery or serous
• Allergic one or xerophthalmia
ropy filamentous
Conjunctival edema
Subconjunctival hemorrhage
Physical sign
papillary hyperplasia:
palpebral conjunctival epithelium
follicular formation:
accumulation of lymphocyte
beneath the conjunctival epithelium
Physical sign
pseudomembrane or membrane : the
exudation rich in fibrin from palpebral
conjunctiva .
Pseudomembrane: in baby and
children, adenoviral, neonatal
inclusion, streptococcal conj.
True membrane: diphtheritic conj.
Conjunctivitis Examination and diagnosis
• Clinical examination
• Cytologic examination
smear of conjunctival and scaling
smear of conjunctiva
• Bacteriological examination
bacterial culture and drug sensitive
test
• Virus isolation and its antigenic
detection
Conjunctivitis Principle treatment
• Remove pathogenic cause, take
local phamacotherapy as major,
systemic treatment as supplement
if necessary
• 1)instillation of eyedrops
2)instillation of ointment
3)washing of conjunctival sac
4)systemic treatment
• Prevention
Hyperacute Bacterial conjunctivitis
Hyperacute purulent
conjunctivitis with the strongest
infectivity and large destructibility
Etiology: diplococcus
gonorrhoeae
adult: auto infection
children: touch infection
newborn: direct infection
Hyperacute Bacterial conjunctivitis
Clinical findings
1)incubation period: 10h-2, 3d, acute onset
2)opthalmalgia, photophobia, tearing
3)swelling of the eyelids
palpebral and bulbar hyperemia and chemosis
secretion: serous-bloody-purulent-nong lou
yan
inflammatory pseudomembrane
preauricular lymphadenectasis
corneal ulcer and perforation
Hyperacute Bacterial conjunctivitis
Diagnosis:
clinical findings
lab examination(Gram’ stain, G- diplococcus)
Treatment:
topical and systemic one is the same important
Prevention
be isolated to avoid infection and epidemic
Bacterial conjunctivitis
Acute catarrhal conjunctivitis
Clinical finding:acute onset(1-3days),
both eye
tearing, foreign body and burning
sensation
conjunctival hyperemia, purulent
secretion, palpebral swelling, spots of
subconjunctival hemorrhage
Ill process: 2 weeks
Bacterial conjunctivitis
Acute catarrhal conjunctivitis
Bacterial conjunctivitis
Chronic catarrhal conjunctivitis
Etiology
bacterial infection:
acute-chronic or infection of bacterial
with weak toxicity
– non-infectious
environment factors: dust, chemical
smoke or gas and irritating eye drugs
– complicated from other disorders
Bacterial conjunctivitis
Chronic catarrhal conjunctivitis
Clinical finding:
chronic onset, both eye
itching, foreign body and asthenopia or
no symptoms
conjunctival hyperemia
mucous secretion
papillary and follicle hyperplasia
Treatment: give management
according to different causes
Bacterial conjunctivitis
Chronic catarrhal conjunctivitis
Chlamydial conjunctivitis
Chlamydin psittaci:
Chlamydia trachomatis:
antigen:ABCBa
DEFGHIJK
trachoma
genitourinary
system inclusion
conjunctivitis
clinical findings
Acute or subacute stage(1-2mon):
photophobia, tearing, foreign body
sensation
1)palpebral and bulbar conjunctival
hyperemia
2)ropy secretion
3)papillary hyperplasia, follicles
formation
4)corneal epithelitis
be cured without scar left
clinical findings
• Acute stage
Clinical findings
Chronic stage: superinfections or
concomitant bacterial infections
1)Conjunctival hyperemia
2)ropy secretion
3)papillary hyperplasia, follicles
in upper fornix and palpebral
conjunctiva
conjunctival thickening
scar white luster like tenden
4)corneal epithelitis
trachomatous
pannus
Clinical findings
• Chronic stage
Classification
Our country
I progressive stage
papillae and follicles,
upper fornix is blurred,
corneal panus
II regressive stage
scar,a little active lesion
III complete cicatricial stage
scar, no active lesion and
infectivity
Mac Callan’s
I Early stage of infiltration
hyperemia and thickening
early follicle and corneal
panus
II active stage
papillae and follicles,
corneal panus
III precicatricial stage
IV cicatricial stage
Equela and complication
Entropion and trichiasis
Blepharopatosis
Symblepharon (lower fornix)
Parenchymatous xerosis of
conjunctiva
Chronic dacryocystitis
Corneal pannus
Diagnosis
1)the vessels of upper fornix and
palpebral conjunctiva are blurred,
congested, papillary hyperplasia or
follicle formation or both
2)corneal pannus
3)scar
4)trachomatous inclusion
Diagnosis
on the basis of the first plus one of
other three
antigenic test
Scar
corneal pannus
Treatment
Topical
Systemic
tetracyclin,
erythromycin
sulfadiazine
rifampin
Operative: sequelae and
complication
Viral conjunctivitis
Epidemic keratoconjunctivitis
Acute onset, strong
infectivity, may be sporadic
or epidemic
Etiology: adenovirus, type 8,
19, 29 and 37.
Viral conjunctivitis
Epidemic keratoconjunctivitis
Clinical findings:
1)incubation period: 5-7d.
2)foreign body sensation, itching, pain,
photophopia and tearing
3)palpebral edema, conjunctival
hyperemia and chemosis, less and
watery secretion, follicles in palpebral
and fornix conjunctiva, preauricular
lymphadeectasis and tenderness
4)be cured after one week
exacerbate: superfial punctate keratitis
Viral conjunctivitis
Epidemic keratoconjunctivitis
Diagnosis:
Acute folliclar cinjunctivitis
superfial punctate keratitis
preauricular lymphadenectasis
neutrophial
Treatment: no specific drug
1)antiviral:topical(mainly) and systemicacyclic
2)antibiotic
Viral conjunctivitis
Epidemic hemorrhagic conjunctivitis
Fulminant epidemic ocular
infections
Etiology:
entero-virus type 70, picornavirus
Coxsackie virus type A 24
Viral conjunctivitis
Epidemic hemorrhagic conjunctivitis
Clinical findings:
1)incubation period: 24hr
2)ill course: self-limited, 10d or shorter
3)ophthalmagia, foreign body sensation,
photophopia and tears
4)eyelid and conjunctiva red and swollen,
watery secretion, follicular hyperplasis of
palpebral conjunctiva, patchy hemorrhage on
bulbar conjunctiva, preauricular
lymphadenectasis
5) Transient fine punctate epithelial keratitis
Immunologic conjunctivitis
Vernal conjunctivitis (Clinical findings)
Symptom:extreme itching
Sign
1)palpebral type:
papillary hyperplasia in the upper
palpebral conjunctiva that like oval
flat cobblestone, eosinophillia in
secretion
2)corneal limbal type:
collid tubercles at the corneal limbus
3)mixed type:
Vernal conjunctivitis
Vernal conjunctivitis
Treatment:
1)self-limited, no vision affected
2)general treatment:
keep away proble sensitinogen
3)medical treatment:
natrii cromoglycas
corticosteroid
Allergic conjunctivitis
Immediated allergic antigen:
pollen, contact lens, etc.
Delayed one: various drug
Clinical findings:
immediate type: dermatitis of
palpebral skin, blepharitis,
mild infiltrative conjunctivitis
Allergic conjunctivitis
Lab examination:
degenerative epithelial cell, few
polynuclear cells and mononuclear
cells in secretion
Treatment:
1)find out and get rid of sensitinogen
2)corticosteroid
3)3% boric solution
4)anti-allergic agents
Phlyctenular keratoconjunctivitis
Etiology: delayed reaction to
protein of microorganism, mostly
to mycobecterium tuberculosis
and staphylococcus aureus
Clinical findings: herpetic
tubercle may appear on the
bulbar conjunctiva or limbus.
Pterygium
Etiology: unclear, outdoor work
Clinical findings:
1)hypertrophic bular conjunctiva and its
subconjunctival tissue invade onto the
cornea with the shape of tiangle
2)composed of head, neck, body.
3)progressive, stationary
4)differentiated with pseudopterygium
Treatment: operation
Pingueculae
A degenerative lesion of the
bulbar conjunctiva caused by the
effect of ultraviolet rays
Clinical findings:
a kind of white–yellow
amorphous subepithelial
deposition near to the limbus
Treatment: no needed
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Pterygium
Pingueculae
Conjunctival concretion
• Concrement on the palpebral
conjunctiva
• Old or those with chronic
conjunctivitis
• White-yellow deposit
• Treatment:
no need
be rejected
Primary benign tumors of the
conjunctiva
nevi
Dermolipoma
angioma
Primary malignant tumors of the
bulbar conjunctiva
Squamous
cell carcinoma
Malignant
melanoma
Subconjunctival hemorrhage
• Caused by vascular rupture beneath
the bulbar conjunctiva or by osmotic
increase of vascular wall
• Treatment:
1)find out the cause
2)good explanation