a.superficial (adenoid layer).contain lymphoid tissue.

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1 Conjunctiva Dr. saifalshamarti Anatomy Microscopic: 1.Epithelium (non keratinized,includes goblet cell). 2.Epithelial basement membrane. 3.Stroma : a.superficial (adenoid layer).contain lymphoid tissue. b.deep (fibrous layer). Macroscopic : 1.Palpepral 2.Forniceal 3.Bulbar

2 Lymphatics drain in sub mandibular and preauricular lymph node. Conjunctiva has comparatively few pain fiber From the trigeminal nerve (ophthalmic division) So pain is poorly localized. Conjunctival signs and symptoms 1.Redness Key symptoms include: 2.Surface irritation. 3.Itching. 4.Discharge. 5.Watering. 6.Conjunctival swelling Examination Hyperaemia.(localized or diffuse). Chemosis: edematous conjunctiva. Sub conjunctival haemorrhage. Discharge..if mucoserous or watery (viral or toxic)..if mucopurulent (bacterial )..watery (allergic). Follicle :focal lymphoid aggregates in substantia p. Papillae: vascular response(central tuft of vessels) Either small or giant papillae. Conjunctivitis Definition Conjunctivitis: inflammation of mucous membrane that lines the inner surface of the lids and the globe up to the limbus (junction of the sclera and the cornea)

3 Etiology Infectious Bacterial Viral Noninfectious Allergic Non-Allergic Diagnosis Can usually be diagnosed by history and physical exam Cultures are usually unnecessary Exception: hyperacute cases, in which gram stain/giemsa stain for N. gonorrhoeae would be useful Red Eye Inflammation of conjunctiva leads to pink or red appearance, Other etiologies of red eye: Acute angle closure glaucoma Hyphema Iritis keratitis Stye Blepharitis Corneal abrasion Dry Eye syndrome Episcleritis&scleritis Bacterial Conjunctivitis Symptoms: redness and mucopurulent discharge in the eye, affected eye often is stuck Common organisms: S. aureus, S. pneumoniae, H. influenzae, M. catarrhalis Hyperacute bacterial conjunctivitis: N. gonorrhoeae (seen with concurrent urethritis)

4 There is often profuse purulent discharge, chemosis, lid swelling, tender preauricular adenopathy Treatment: antibiotics can shorten duration of disease if given before day 6 Erythromycin ointment or polymyxin/trimethoprin drops are most often used Viral Conjunctivitis Symptoms: injection, watery/mucoserous discharge, burning /sandy/gritty feeling in on eye, scant mucus, often bilateral Common organisms: adenovirus On Exam: profuse tearing/mucoid discharge, enlarged/tender preauricular node. Can lead to keratitis (inflammation of the cornea), with symptoms of a foreign body sensation and multiple corneal infiltrates Treatment: symptomatic relief with topical antihistamine/decongestants, warm/cool compresses Adult Inclusion Conjunctivitis Chronic form of conjunctivitis caused by certain serotypes of Chlamydia trachomitis Often presents with concurrent asymptomatic urogenital infection Symptoms: unilateral follicular conjunctivitis that does not respond to topical antibiotic therapy Diagnosis: Giemsa staining of conjunctival smears or by culture/pcr of swabbed organisms Treatment: systemic therapy with doxycycline, tetracycline, erythromycin or azithromycin Allergic Conjunctivitis Symptoms: bilateral redness, watery discharge, itching, marked chemosis.

5 Patients often have a hx of atopy, seasonal allergy or specific allergy Noninfectious, Nonallergic Conjunctivitis Often due to mechanical or chemical insult, transient, resolves in 24 hours without treatment Symptoms: mucoid discharge Treatment: topical lubricants Resolution of Symptoms Bacterial conjunctivitis should improve within 1-2 days All other forms should improve within 1-2 weeks Neonatal conjunctivitis Neonatal conjunctivitis includes bacterial, viral, and chemical causes Time of disease onset is a clue to etiology Gram stain and culture of discharge Treatment based on etiology Early treatment is necessary to prevent further permanent eye damage Chemical Conjunctivitis Silver nitrate solution used as prophylaxis for bacterial conjunctivitis Occurs within the first 5 days of life Spontaneous resolution Decreasing incidence due to use of erythromycin drops Bacterial Conjunctivitis Neisseria gonorrhoeae Chlamydia trachomatis Gram positive cocci (30-50% cases) Some gram negatives Prophylaxis includes topical erythromycin and silver nitrate at birth.

6 Gonococcal Conjunctivitis Occurs 2-7 days after birth More severe than other forms Bilateral purulent discharge May progress to corneal involvement with perforation or endophthalmitis Possible systemic manifestations Treatment includes topical erythromycin, IV or IM 3 rd generation cephalosporin, and Penicillin G (for penicillin susceptible organisms) Chlamydial Conjunctivitis Occurs 5-14 days after birth Watery discharge, involvement of eyelids, pannus, possible corneal scarring with eyelashes Treatment involves oral erythromycin for 2 weeks Colonization of the nasopharynx causes atypical pneumonia Viral Conjunctivitis HSV keratoconjunctivitis Occurs within the first 2 weeks of life Corneal epithelium involvement, skin lesions around eyes, risk of encephalitis C-section if mother has active lesions Treated with IV acyclovir for 2-3 weeks