Cysts, tumors and degenerations of
conjunctiva
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CONJUNCTIVAL CYSTS AND TUMOURSCommon cysts found in the conjunctiva are due to dilatation
of lymph spaces
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Tumours? Congenital- dermoids, dermolipoma
? Squamous Cell Carcinoma (Epithelioma)
? Basal Cell Carcinoma (Rodent Ulcer)
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? Lymphomas? Kaposi Sarcoma
CYSTS OF CONJUNCTIVA
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1. Congenital cystic lesions.2. Lymphatic cysts of conjunctiva.
3. Retention cysts.
4. Epithelial implantation cyst
5. Parasitic cysts
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6. Aqueous cyst.Treatment:
Wait and watch
Excision biopsy
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TUMOURS OF THE CONJUNCTIVA
Classification
Non-pigmented tumours
I. Congenital: dermoid and lipodermoid (choristomas).
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II. Benign: simple granuloma, papilloma, adenoma,fibroma and angiomas.
III. Premalignant: intraepithelial epithelioma (Bowen's disease).
IV. Malignant: epithelioma or squamous cell carcinoma, basal
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cell carcinoma.Pigmented tumours
I. Benign: naevi or congenital moles.
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II. Precancerous melanosis: superficial spreading melanomaand lentigo maligna (Hutchinson's freckle).
III. Malignant: primary melanoma (malignant melanoma).
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? Dermoids
? lenticular yellow tumours,
? At the corneal margin, most
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commonly at the outer side? Consist of epidermoid
epithelium with sebaceous
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glands and hair
? Syndromic associations
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Pigmented Tumours
Naevi or congenital mole
Precancerous melanosis
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Malignant melanomaMalignant melanoma
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DEGENERATIVE CHANGES IN THE CONJUNCTIVAConcretions (Lithiasis)
Pterygium
Pinguecula
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Concretions (Lithiasis)These occur as minute, hard, yellow spots in
the palpebral conjunctiva.
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Concretions are formed due to theaccumulation of epithelial cells and
inspissated mucus in depressions called Henle
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glands.
Foreign body sensation
Treatment: Remove with a sharp
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needle.
Pterygium
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Pterygium - a wingIt is a triangular encroachment of the vascularized granulation
tissue covered by conjunctiva in the interpalpebral area
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Degenerative condition of the subconjunctival tissuesOften bilateral, usually present on the nasal side
Aetiopathogenesis
Dry sunny climates - Ultraviolet light
Degeneration of the subconjunctival tissues
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Proliferates as avascularized granulation tissue encroachingupon the cornea destroying the superficial layers of the
stroma and Bowman's membrane
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Formation of dense fibrous tissue leads to the development of
corneal astigmatism
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Clinical features? Symptoms
? Foreign body sensation
? Watering
? Redness (inflamed)
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? Blurring of vision due to induced astigmatism orprogression into the pupillary area of the cornea
Head
Body
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Neck
Cap
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TypesProgressive
Regressive
Atrophic
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Various forms of pterygium, including simultaneous nasal and temporal pterygium (A),
quiescent nasal pterygium (B), inflammatory nasal pterygium (C) and inflammatory
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temporal pterygium (D).Pseudopterygium
Pinguecula
Limbal dermoid
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Treatment
Observation in early stages
Surgical removal is the only satisfactory treatment
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RecurrenceExcision with conjunctival autograft
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PsuedopterygiumPterygium-like lesion
Induced by cicatrizing conjunctival inflammatory overgrowth
Produced by trauma, thermo-chemical burn or chronic
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conjunctivitis
chemical
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PterygiumPsuedopterygium
1. Degenerative process
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? 1. Inflamatory process
2. Common in elderly
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? 2. Can occur at any agepersons
3. Always situated in the
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? 3. Can occur at any site
palpebral aperture
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4. Progressive regressive or? 4. Non progressive
stationery
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5. Probe test negative
? 5. Probe test positive
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Pinguecula
This is a triangular patch on the conjunctiva
Yellow in colour and looks like fat, hence the name (pinguis,
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fat).Found in elderly people, especially those exposed to strong
sunlight, dust, wind, etc.
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Pterygium frequently follows a pinguecula.
It is due to hyaline infiltration and elastotic degeneration of
the sub-mucous tissue.
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It requires no treatment.
Viral conjunctivitis
1.Acute serous conjunctivitis
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2. Acute haemorrhagic conjunctivitis3. Acute follicular conjunctivitis
ACUTE SEROUS CONJUNCTIVITIS
Etiology: Mild grade viral infection which does not give rise
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to follicular response.
Clinical features.
Characterised by a minimal degree of congestion, a watery
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discharge and a boggy swelling of the conjunctival mucosa.
Treatment.
Usually it is self-limiting
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Broad spectrum antibiotic eye drops.ACUTE HAEMORRHAGIC CONJUNCTIVITIS
Multiple conjunctival haemorrhages, conjunctival hyperaemia
and mild follicular hyperplasia.
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Etiology: Enterovirus 70.
No specific effective treatment.
Broad spectrum antibiotic eye drops may be used to prevent
secondary bacterial infections.
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Usually the disease has a self-limiting course of 5-7 days.FOLLICULAR CONJUNCTIVITIS
1. Acute follicular conjunctivitis.
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2. Chronic follicular conjunctivitis.3. Specific type of conjunctivitis
1. Acute follicular conjunctivitis.
Adult inclusion conjunctivitis
Epidemic keratoconjunctivitis
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Pharyngoconjunctival feverNewcastle conjunctivitis
Acute herpetic conjunctivitis
Treament
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Symptomatic
Prevention of secondary infection.