Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Degenerative Conditions of Conjuctiva PowerPoint PPT presentation
CONDITIONS OF
CONJUCTIVA
PINGUECULA
Pinguecula is an extremely common degenerative
condition of the conjunctiva
It is characterized by formation of a yellowish white
patch on the bulbar conjunctiva near the limbus
ETIOLOGY
Etiology of pinguecula is not known exactly
It has been considered as an age-change, occurring
more commonly in persons exposed to strong
sunlight, dust and wind
PATHOGENESIS
There is an elastotic degeneration of collagen fibres of
the substantia propria of conjunctiva, coupled with
deposition of amorphous hyaline material in the
substance of conjunctiva
Clinical features
Pinguecula is a bilateral, usually stationary condition,
presenting as yellowish white triangular patch near
the limbus
Apex of the triangle is away from the cornea
It affects the nasal side first and then the temporal
side
When conjunctiva is congested, it stands out as an
avascular prominence
Complications
Inflammation
Intraepithelial abscess formation
Calcification
doubtful conversion into pterygium
Treatment
In routine no treatment is required for pinguecula
However, when cosmetically unaccepted and if so
desired, it may be excised
When inflamed it is treated with topical steroid
PTERYGIUM
Pterygium is a wing-shaped fold of conjunctiva
encroaching upon the cornea from either side within
the interpalpebral fissure
Etiology
Etiology of pterygium is not definitely known
But the disease is more common in people living in
hot climates
it is a response to prolonged effect of environmental
factors such as exposure to sun (ultraviolet rays), dry
heat, high wind and abundance of dust.
Pathology
Pathologically pterygium is a degenerative and
hyperplastic condition of conjunctiva
The subconjunctival tissue undergoes elastotic
degeneration and proliferates as vascularised
granulation tissue under the epithelium, which
ultimately encroaches the cornea
The corneal epithelium, Bowman's layer and
superficial stroma are destroyed
Clinical features
Demography
Age: Usually seen in old age
Sex: More common in males doing outdoor work than
females
Laterality: It may be unilateral or bilateral. Usually
present on the nasal side but may also occur on the
temporal side
Symptoms
Cosmetic intolerance may be the only issue in
otherwise asymptomatic condition in early stages
Foreign body sensation and irritation may be
experienced
Defective vision occurs when it encroaches the
pupillary area or due to corneal astigmatism induced
by fibrosis in the regressive stage
Diplopia may occur occasionally due to limitation of
ocular movements.
Signs
Pterygium presents as a triangular fold of conjunctiva
encroaching on the cornea in the area of palpebral
aperture usually on the nasal side
? But may also occur on the temporal side
? Very rarely, both nasal and temporal sides are
involved
Parts
Head: Apical part present on the cornea
Neck: Constricted part present in the limbal area, and
Body: Scleral part, extending between limbus and the
canthus
Cap: Semilunar whitish infiltrate present just in front
of the head
Types
Progressive pterygium is thick, fleshy and vascular
with a few whitish infiltrates in the cornea, in front of
the head of the pterygium known as Fuch's spots or
islets of Vogt also called cap of pterygium
Regressive pterygium is thin, atrophic, attenuated
with very little vascularity. There is no cap, but
deposition of iron (Stocker's line) may be seen
sometimes, just anterior to the head of pterygium
Complications
Cystic degeneration and infection are infrequent
Neoplastic change to epithelioma, fibrosarcoma or
malignant melanoma, may occur rarely
Treatment
Surgical excision is the only satisfactory treatment,
which may be indicated for
Cosmetic disfigurement.
Visual impairment due to significant regular or
irregular astigmatism
Continued progression threatening to encroach onto
the pupillary area (once the pterygium has
encroached pupillary area, wait till it crosses on the
other side).
Diplopia due to interference in ocular movements.
Recurrence of the pterygium after surgical excision is
the main problem (30?50%).
it can be reduced by,
Surgical excision with free conjunctival limbal
autograft (CLAU) taken from the same eye or other eye
is presently the preferred technique
Surgical excision with amniotic membrane graft and
mitomycin-C (MMC) (0.02%) application may be
required in recurrent pterygium or when dealing with a
very large pterygium.
Surgical excision with lamellar keratectomy and
lamellar keratoplasty may be required in deeply
infiltrating recurrent recalcitrant pterygia
Surgical technique of pterygium
excision
After topical anaesthesia, eye is cleansed, draped and
exposed using universal eye speculum
Head of the pterygium is lifted and dissected off the cornea
very meticulously
Main mass of pterygium is then separated from the sclera
underneath and the conjunctiva superficially.
Pterygium tissue is then excised taking care not to damage
the underlying medial rectus muscle
. Haemostasis is achieved and the episcleral tissue exposed
is cauterised thoroughly
Conjunctival limbal autograft (CLAU) transplantation to
cover the defect after pterygium excision
CONCRETIONS
Etiology
Concretions are formed due to accumulation of
inspissated mucus and dead epithelial cell debris into
the conjunctival depressions called loops of Henle
They are commonly seen in elderly people in a
degenerative condition and also in patients with
scarring stage of trachoma
Clinical features
Concretions are seen on palpebral conjunctiva, more
commonly on upper than the lower.
They may also be seen in lower fornix
These are yellowish white, hard looking, raised areas,
varying in size from pin point to pin head
It produce foreign body sensations and lacrimation by
rubbing the corneal surface
Treatment
It consists of their removal with the help of a
hypodermic needle under topical anaesthesia
AMYLOID DEGENERATION OF
CONJUNCTIVA
Etiology
? two forms
? Primary conjunctival amyloid is associated with
deposition of light-chain immunoglobulin by the
monoclonal B cells and plasma cells
? Secondary conjunctival amyloid may occur secondary
to systemic diseases or secondary to chronic
conjunctival inflammations.
Clinical features
Deposition of yellowish, well-demarcated, irregular
amyloid material in the conjunctiva with superior
fornix and tarsal conjunctiva being more commonly
involved areas.
Subconjunctival haemorrhage may be associated with
amyloid deposition in blood vessels.
Treatment
Lubricating drops for mild symptoms
Excision biopsy can be performed in patients with
marked irritation due to raised lesions
THANK YOU
This post was last modified on 12 August 2021