DEGENERATIVE
CONDITIONS OF
CONJUCTIVA
PINGUECULA
Pinguecula is an extremely common degenerative
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
more commonly in persons exposed to strong
sunlight, dust and wind
PATHOGENESIS
There is an elastotic degeneration of collagen fibres of
deposition of amorphous hyaline material in the
substance of conjunctiva
Clinical features
Pinguecula is a bilateral, usually stationary condition,
the limbus
Apex of the triangle is away from the cornea
It affects the nasal side first and then the temporal
side
avascular prominence
Complications
Inflammation
Intraepithelial abscess formation
doubtful conversion into pterygium
Treatment
In routine no treatment is required for pinguecula
However, when cosmetically unaccepted and if so
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
Etiology
Etiology of pterygium is not definitely known
But the disease is more common in people living in
hot climates
factors such as exposure to sun (ultraviolet rays), dry
heat, high wind and abundance of dust.
Pathology
Pathologically pterygium is a degenerative and
The subconjunctival tissue undergoes elastotic
degeneration and proliferates as vascularised
granulation tissue under the epithelium, which
ultimately encroaches the cornea
superficial stroma are destroyed
Clinical features
Demography
Age: Usually seen in old age
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
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
involved
Parts
Head: Apical part present on the cornea
Neck: Constricted part present in the limbal area, and
canthus
Cap: Semilunar whitish infiltrate present just in front
of the head
Types
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
deposition of iron (Stocker's line) may be seen
sometimes, just anterior to the head of pterygium
Complications
Cystic degeneration and infection are infrequent
malignant melanoma, may occur rarely
Treatment
Surgical excision is the only satisfactory treatment,
which may be indicated for
Visual impairment due to significant regular or
irregular astigmatism
Continued progression threatening to encroach onto
the pupillary area (once the pterygium has
other side).
Diplopia due to interference in ocular movements.
Recurrence of the pterygium after surgical excision is
the main problem (30?50%).
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
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
Surgical technique of pterygium
excision
After topical anaesthesia, eye is cleansed, draped and
exposed using universal eye speculum
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
. 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
degenerative condition and also in patients with
scarring stage of trachoma
Clinical features
Concretions are seen on palpebral conjunctiva, more
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
Treatment
It consists of their removal with the help of a
hypodermic needle under topical anaesthesia
AMYLOID DEGENERATION OF
Etiology
? two forms
? Primary conjunctival amyloid is associated with
deposition of light-chain immunoglobulin by the
? Secondary conjunctival amyloid may occur secondary
to systemic diseases or secondary to chronic
conjunctival inflammations.
Clinical features
amyloid material in the conjunctiva with superior
fornix and tarsal conjunctiva being more commonly
involved areas.
Subconjunctival haemorrhage may be associated with
Treatment
Lubricating drops for mild symptoms
Excision biopsy can be performed in patients with
marked irritation due to raised lesions
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CONDITIONS OF
CONJUCTIVA
PINGUECULA
Pinguecula is an extremely common degenerative
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condition of the conjunctivaIt is characterized by formation of a yellowish white
patch on the bulbar conjunctiva near the limbus
ETIOLOGY
Etiology of pinguecula is not known exactly
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It has been considered as an age-change, occurringmore commonly in persons exposed to strong
sunlight, dust and wind
PATHOGENESIS
There is an elastotic degeneration of collagen fibres of
--- Content provided by FirstRanker.com ---
the substantia propria of conjunctiva, coupled withdeposition of amorphous hyaline material in the
substance of conjunctiva
Clinical features
Pinguecula is a bilateral, usually stationary condition,
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presenting as yellowish white triangular patch nearthe limbus
Apex of the triangle is away from the cornea
It affects the nasal side first and then the temporal
side
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When conjunctiva is congested, it stands out as anavascular prominence
Complications
Inflammation
Intraepithelial abscess formation
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Calcificationdoubtful conversion into pterygium
Treatment
In routine no treatment is required for pinguecula
However, when cosmetically unaccepted and if so
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desired, it may be excisedWhen inflamed it is treated with topical steroid
PTERYGIUM
Pterygium is a wing-shaped fold of conjunctiva
encroaching upon the cornea from either side within
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the interpalpebral fissureEtiology
Etiology of pterygium is not definitely known
But the disease is more common in people living in
hot climates
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it is a response to prolonged effect of environmentalfactors such as exposure to sun (ultraviolet rays), dry
heat, high wind and abundance of dust.
Pathology
Pathologically pterygium is a degenerative and
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hyperplastic condition of conjunctivaThe subconjunctival tissue undergoes elastotic
degeneration and proliferates as vascularised
granulation tissue under the epithelium, which
ultimately encroaches the cornea
--- Content provided by FirstRanker.com ---
The corneal epithelium, Bowman's layer andsuperficial stroma are destroyed
Clinical features
Demography
Age: Usually seen in old age
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Sex: More common in males doing outdoor work thanfemales
Laterality: It may be unilateral or bilateral. Usually
present on the nasal side but may also occur on the
temporal side
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Symptoms
Cosmetic intolerance may be the only issue in
otherwise asymptomatic condition in early stages
Foreign body sensation and irritation may be
experienced
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Defective vision occurs when it encroaches thepupillary area or due to corneal astigmatism induced
by fibrosis in the regressive stage
Diplopia may occur occasionally due to limitation of
ocular movements.
--- Content provided by FirstRanker.com ---
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
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? Very rarely, both nasal and temporal sides areinvolved
Parts
Head: Apical part present on the cornea
Neck: Constricted part present in the limbal area, and
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Body: Scleral part, extending between limbus and thecanthus
Cap: Semilunar whitish infiltrate present just in front
of the head
Types
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Progressive pterygium is thick, fleshy and vascularwith 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
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with very little vascularity. There is no cap, butdeposition of iron (Stocker's line) may be seen
sometimes, just anterior to the head of pterygium
Complications
Cystic degeneration and infection are infrequent
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Neoplastic change to epithelioma, fibrosarcoma ormalignant melanoma, may occur rarely
Treatment
Surgical excision is the only satisfactory treatment,
which may be indicated for
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Cosmetic disfigurement.Visual impairment due to significant regular or
irregular astigmatism
Continued progression threatening to encroach onto
the pupillary area (once the pterygium has
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encroached pupillary area, wait till it crosses on theother side).
Diplopia due to interference in ocular movements.
Recurrence of the pterygium after surgical excision is
the main problem (30?50%).
--- Content provided by FirstRanker.com ---
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
--- Content provided by FirstRanker.com ---
mitomycin-C (MMC) (0.02%) application may berequired in recurrent pterygium or when dealing with a
very large pterygium.
Surgical excision with lamellar keratectomy and
lamellar keratoplasty may be required in deeply
--- Content provided by FirstRanker.com ---
infiltrating recurrent recalcitrant pterygiaSurgical technique of pterygium
excision
After topical anaesthesia, eye is cleansed, draped and
exposed using universal eye speculum
--- Content provided by FirstRanker.com ---
Head of the pterygium is lifted and dissected off the corneavery 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
--- Content provided by FirstRanker.com ---
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
--- Content provided by FirstRanker.com ---
CONCRETIONS
Etiology
Concretions are formed due to accumulation of
inspissated mucus and dead epithelial cell debris into
the conjunctival depressions called loops of Henle
--- Content provided by FirstRanker.com ---
They are commonly seen in elderly people in adegenerative condition and also in patients with
scarring stage of trachoma
Clinical features
Concretions are seen on palpebral conjunctiva, more
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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
--- Content provided by FirstRanker.com ---
rubbing the corneal surfaceTreatment
It consists of their removal with the help of a
hypodermic needle under topical anaesthesia
AMYLOID DEGENERATION OF
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CONJUNCTIVAEtiology
? two forms
? Primary conjunctival amyloid is associated with
deposition of light-chain immunoglobulin by the
--- Content provided by FirstRanker.com ---
monoclonal B cells and plasma cells? Secondary conjunctival amyloid may occur secondary
to systemic diseases or secondary to chronic
conjunctival inflammations.
Clinical features
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Deposition of yellowish, well-demarcated, irregularamyloid material in the conjunctiva with superior
fornix and tarsal conjunctiva being more commonly
involved areas.
Subconjunctival haemorrhage may be associated with
--- Content provided by FirstRanker.com ---
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
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