Download MBBS Ophthalmology PPT 26 Cysts And Tumours Of Conjunctiva Lecture Notes

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CONJUNCTIVAL CYSTS AND TUMOURS
Common 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 melanoma

and 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 melanoma

Malignant melanoma

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DEGENERATIVE CHANGES IN THE CONJUNCTIVA
Concretions (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 the

accumulation 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 wing
It 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 tissues
Often 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 encroaching

upon 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 or

progression into the pupillary area of the cornea
Head
Body

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Neck

Cap

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Types
Progressive
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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Recurrence

Excision with conjunctival autograft

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Psuedopterygium

Pterygium-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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Pterygium

Psuedopterygium

1. Degenerative process

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? 1. Inflamatory process

2. Common in elderly

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? 2. Can occur at any age

persons

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 conjunctivitis
3. 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 fever
Newcastle conjunctivitis
Acute herpetic conjunctivitis

Treament

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Symptomatic
Prevention of secondary infection.