Transcript Disease of the cornea

Disease of the
conjunctiva
General description of conjunctivitis
Conjunctivitis:the most common
extraocular disorder
Etiology:
infection of microorganism
physical injuries
chemical injuries
allergic disorder
immunological disorder
nutritional deficiency
General description of conjunctivitis
Classification
According to the cause: bacterial,
chlamydial, viral, fungal, allergic
conjunctivitis
According to the course: acute,
subacute and chronic
General description of conjunctivitis
Clinical manifestation
 Symptoms:foreign body sensation, burning
sensation, itching and tearing, pain and
photophobia when cornea is involved
 Physical sign:
1)conjunctival hyperemia and edema:
situation, movable, adrenalin test
2)increase of secretion:
bacterial:serous,mucous and purulent
viral: watery or serous
allergic one or xerophthalmia: ropy filamentous
General description of conjunctivitis
Clinical manifestation
 Physical sign
3)subconjunctival hemorrhage
4)papillary hyperplasia:
palpebral conjunctival epithelium;
follicular formation:
accumulation of lymphocyte beneath the
conjunctival epithelium, seen in
chlamydial and drug-induced
conjunctivitis
General description of conjunctivitis
Clinical manifestation
 Physical sign:
5)pseudomembrane or membrane of the
palpebral conjunctiva: the exudation rich in
fibrin from palpebral conjunctiva .
Pseudomembrane: in baby and children,
adenoviral, neonatal inclusion, streptococcal conj.
True membrane: diphtheritic conj.
6)preauricular lymphadenectasis with tenderness:
viral conj.
General description of 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
General description of 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
Bacterial conjunctivitis
Acute catarrhal conjunctivitis
 “pink eye”, in spring and autumn, sporadic
or epidemic
 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
 Treatment
 Prevention
Bacterial conjunctivitis
Chronic catarrhal conjunctivitis
Etiology
1)bacterial infection:
acute-chronic or infection of bacterial
with weak toxicity
2)non-infectious:
environment factors: dust, chemical
smoke or gas and irritating eye drugs
3)complicated from other disorders:
Bacterial conjunctivitis
Chronic catarrhal conjunctivitis
Clinical finding:
1)chronic onset, both eye
2)itching, foreign body and asthenopia
or no symptoms
3)conjunctival hyperemia
mucous secretion
papillary and follicle hyperplasia
Treatment: give management according
to different causes
Bacterial conjunctivitis
Gonococcal conjunctivitis
Hyperacute purulent conjunctivitis
with the strongest infectivity and
large destructibility
Etiology: diplococcus gonorrhoeae
adult: auto infection
children: touch infection
newborn: direct infection
Bacterial conjunctivitis
Gonococcal 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
Bacterial conjunctivitis
Gonococcal 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
Chlamydial conjunctivitis
 Chlamydia is microorganism between
bacterium and virus
 Chlamydin psittaci:
Chlamydia trachomatis:
antigen:ABCBa
DEFGHIJK
trachoma genitourinary system
inclusion conjunctivitis
 Chlamydia is sensitive to tetracyclin or
erythromycin
Chlamydial conjunctivitis
Trachoma
 A chronic, infectious keratoconjunctivits
 Named from rough, uneven appearance on the
surface of palpebral conjunctiva that looks like
sand
 Our country:
before 1950s: the first cause of blindness
1955: separated the pathogen
after 1970s: decreased greatly
now: remote districts
 Developing countries of the Asian-African area
Chlamydial conjunctivitis
Trachoma(clinical findings)
 Commonly occurred in children and juvenile,
with bilateral acute or subacute onset
 Incubation time: 5-14d(children), 7d(average)
 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
Chlamydial conjunctivitis
Trachoma(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
Chlamydial conjunctivitis
Trachoma(classification)
Our country
Mac Callan’s
I Early stage of infiltration
hyperemia and thickening
early follicle and corneal panus
I progressive stage
papillae and follicles,
upper fornix is blurred,
corneal panus
II active stage
papillae and follicles,
corneal panus
II regressive stage
scar,a little active lesion
III precicatricial stage
III complete cicatricial stage
scar, no active lesion and infectivity
IV cicatricial stage
Chlamydial conjunctivitis
Trachoma(sequela and complication)
Entropion and trichiasis
Blepharopatosis
Symblepharon (lower fornix)
Parenchymatous xerosis of conjunctiva
Chronic dacryocystitis
Corneal opacity
Chlamydial conjunctivitis
Trachoma(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
Chlamydial conjunctivitis
Trachoma(differential diagnosis)
 Chronic follicular conjunctivitis
1)follicles in lower palpebral /fornix conjunctiva, no
fusion tendency, translucent, conjunctiva is not thickened
2)no scar and corneal pannus.
 Spring catarrh
1)papillae are large and flat, no lesion on upper fornix
2)no cornea pannus
3)eosinophil cells in secretion smear
 Inclusion conjunctivitis
1)follicles in lower palpebral and fornix conjunctiva
2)no corneal pannus and scar.
Chlamydial conjunctivitis
Trachoma(treatment)
Topical
tetracyclin, erythromycin
Systemic
sulfadiazine, rifampin
Operative: sequelae and complication
Viral conjunctivitis
 Acute follicullar viral conjunctivitis:
epidemic keratoconjunctivitis
herpes simplex conjunctivitis
epidemic hemorrhagic conjunctivitis
 Relative subacute or chronic conjunctivitis:
besides conjunctivitis, complicated with
palpebral, cornea, as well as systemic
clinical findings
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 systemic-acyclic
2)antibiotic
Viral conjunctivitis
Epidemic hemorrhagic conjunctivitis
Fulminant epidemic ocular infections
Etiology:
entero-virus type 70, picornavirus
Coxsackie virus type A 24
Clinical findings:
1)incubation period: 24hr
2)ill course: self-limited, 10d or shorter
Viral conjunctivitis
Epidemic hemorrhagic conjunctivitis
 Clinical findings:
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
Allergic conjunctivitis
Vernal conjunctivitis(spring catarrh)
 A seasonal disease, also named spring catarrh,
with recurrence in warm spring, summer,
commonly seen in youth (male) with age
under 20 years, bilateral, relapses every year.
 Etiology: unclear, immunologic disorder (type
I of allergic reaction)
sensitinogen: plant pollen, dust, animal
furfurous, feather, sun light temperature,
antigenic components of microorganisms
Allergic 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:
Allergic 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
Allergic conjunctivitis
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.
Tears,tears film and xerosis
Tears
 Mainly produced by the lacrimal gland
and conjunctival goblet cells.
 Volume: 5-9ul
 Major organic component: protein
albumin, globulin, lysozyme
immunoglobulin (IgA,IgG,IgE)
 Main ions: K+Na+Cl A little Lipin, glucose, urea
 PH: 5.20-8.35(7.35)
 isotonic
Tears,tears film and xerosis
Tears film
 Tear film: tears form a thin layer (about 710um thick), composed three layers: lipid,
watery, mucous layer.
 Functions:
1)cover and fill in corneal surface, to make
the cornea be a smooth optic interface
2)moisten and protect corneal and
conjunctival epithelium
3)inhibit the growth of microorganism
through mechanical and antimicrobic effect
4)supply necessary nutrient to the cornea
Tears,tears film and xerosis
primary tear dysfunction
 any abnormality of involved component in
tear film, deficiency of tear secretion or its
abnormal distribution or maintenance
 Rubbing and foreign body sensation, drying
and burning sensation
 Conjunctival hyperemia, mucous filamentous
secretion, papillary hyperplasia, filamentous
keratitis
 Schirmer test, rupture time of the tear film,
fluorescein staining of corneal epithelium
Tears,tears film and xerosis
Xerosis of conjunctiva
 Epithelial xerosis
dificency of vitamin A, when complicated
with corneal epithelial xerosis called
xerophthalmia
 Xerosis of conjunctivae Parenchymatosa
caused by topical ocular disorder
1)cicatricial xerosis of conjunctiva
2)exposure keratoconjunctival xerosis
 Keratoconjunctivitis sicca
an autoimmune disorder, Sjogren syndrome
Tears,tears film and xerosis
Xerosis of conjunctiva
Treatment:
1)etiological treatment
2)treatment against deficiency
of tear secretion
Other common conjunctival disorders
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
Other common conjunctival disorders
Pinquecula
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
Other common conjunctival disorders
Subconjunctival hemorrhage
 Caused by vascular rupture beneath the
bulbar conjunctiva or by osmotic increase of
vascular wall
 Causes: injury, severe cough, conjunctival
inflammation, hypertension, arteriosclerosis,
nephritis, hemotopathy, infectious diseases
 Treatment:
1)find out the cause
2)good explanation
Other common conjunctival disorders
Conjunctival concretion
Concrement on the palpebral conjunctiva
Old or those with chronic conjunctivitis
White-yellow deposit
Treatment:
no need
be rejected