CONJUNCTIVA AND SCLERAL DISEASES

BAGIAN ILMU PENYAKIT MATA

FAKULTAS KEDOKTERAN

UNIVERSITAS HASANUDDIN

Basic Anatomy

The conjunctiva thin vascularmucous membrane that normally of shiny appearance.- forms the conjunctivalsac together with the surface of the cornea

Function

Motility of the eyeball. The loose connection between the bulbar conjunctiva

Articulating layer Protective function

CONJUNCTIVITIS

DefinitionAny form of inflammation of the conjunctiva, marked by vascular dilatation, cellular infiltration and exudation

ClassificationBased On :

a. Causes

b. Age of onset

c. Type of exudates

d. Progressivity

1

Based on the Causes

Bacterial conjunctivitis Most common causesStaph, Strep,

Pneumococcus Acute phase :sign and symptom : vasodilatation

( conjuctival injection) mucopurulen discharge, accompanied by irritation, sticky and foreign body sensation

Chronic phase : slow onset, slowly progress Vision does not affected

Diagnosis

Sign and symptom most reliable Laboratory finding swab culture ( only

if standard treatment tend to fail)

Treatment Bacterial conjunctivitis responds very well to

antibiotic (gentamicin, tobramycin, Aureomycin, chloramphenicol, neomycin, polymyxin B in combination with bacitracin and neomycin , Terramycin,kanamycin, fusidic acid, ofloxacin, and acidamphenicol)

Ointments (longer acting) and eyedrops 1 See Appendix for side effects of medications

Preparations that combine an antibiotic and cortisone can more rapidly alleviate subjective symptoms

Treatment …

Personal hygiene : hold transmission

Prognosis Good, if had sufficient theraphy

Viral Conjunctivitis

Epidemic conjunctivitis, pharyngoconjunctivitis fever, acute haemorrhagik conjuctivitis

highly contagious caused by type 18 or19 adenovirus spread by direct contact

Sign and symptoms

Usually unilateral. Severe lacrimation and itching mucoid discharge Subconj. Bleeding : acute hemorrhagic often also have a moderate influenza

infection Diagnostic considerations: Characteristic

findings include reddening and swelling of the plica semilunaris

Various types

1. PHARINGOCONJUNCTIVA FEVER Marked by pharingitis, fever and follicular conjunctivitis highly contagius phase (10-12 days) Self healing 5-14 days Type 3 adenovirus Identification with netralization test No specific R

2. EPIDEMIC KERATOKONJUNCTIVITIS No systemic symptopms 7-14 days Sometimes accompanied by epithelial keratitis with normal

corneal sensation

3. Acute Haemorrhagic conjunctivitis

conjunctivitis Apollo XI (1969). Caused by enterovirus tipe 70. Short incubation period (8-48

jam) Short lasting (5-7 days) Self limited in 5-7 days

Allergic/ Immunologic Conjunctivitis Hay fever seasonal Vernal conjunctivitis Giant papillary conjunctivitis Phlyctenular conjunctivitis Oculomucocutaneus syndromes ( SSJ,

Lyell’s Syndrome)

Hay fever

IgE mediated immediate hypersensitivity

reactions. The allergen is typically

airborne. Degranulation of mast

cells releases histamine and a variety ofother inflammatory mediators that promote vasodilation, edema, and recruitment of eosinophils

Vernal keratoconjunctivitis

Usually a seasonally recurring, bilateral inflammation of the cornea and conjunctiva,

vernal (springtime) keratoconjunctivitis (VKC) occurs predominantly in male children, who frequently, but not invariably, have a personal or family history of atopy

Phlyctenular conjunctivitis ( delayed onset) Discrete nodular area

of inflammation of conjunctiva

Children, young adults

Poor hygiene Endemic tuberculosis

Giant pail conjuctivitis

Contact lens induced

Foreign body induced

3

Inclusion Conjunctivitis/Newborn conjunctivitis

Chlamidia Conjunctivitis

10

Treatment oral: Tetrasiklin / doksisiklin /

eritromisin Eyedrops / Ointment : Sulfonamid /

tetrasiklin / eritromisin / ripampisin.

Prognosis: Depends on efficiency, adequacy,

immediate theraphy good prognosis

DEGENERATIVE DISEASES OF CONJUNCTIVA

PINGECUELA Harmless grayish yellow thickening of the

conjunctival epithelium in the palpebral fissure.

The harmless thickening of the conjunctiva is due to hyaline degeneration of the subepithelial collagen tissue.

Advanced age and exposure to sun, wind, and dust foster the occurrence of the disorder.

Treatment: No treatment is necessary.

Clinical app

PTERYGIUM Triangular fold of conjunctiva that

usually grows from the medial portion of the palpebral fissure toward the cornea.

Epidemiology: Pterygium is especially prevalent in southern countries due to increased exposure to intense sunlight.

Sign and symptom : when its head

threatens the center of the cornea and visual axis

Tensile forces acting on the cornea can cause severe corneal astigmatism.

impair ocular motility

Treatment : Surgical exision

SCLERITIS

Diffuse or localized inflammation of the sclera

Classification :

According to location:

Anterior (inflammation anterior to the equator of the globe).

Posterior (inflammation posterior to the equator of the globe).

Posterior scleritis

Anterior scleritis classified according to its nature:

Non-necrotizing anterior scleritis (nodular or diffuse).

Necrotizing anterior scleritis (with or without inflammation).

Etiology: Approximately 50% of scleritis cases (which tend to have severe clinical courses) are attributable to systemic autoimmune or rheumatic disease

Sign and symptoms

Unilateral or bilateral reddening Focal/diffuse redness Slight tenderness on palpation, pain on

eye movement (esp. episcleritis) Severe pain on Scleritis (except

scleromalacia perforans)

Diffuse non necrotizing scleritis

Marked thickening andedema of thesclera and deep,diffuse reddening of sclera

Nodular Scleritis

Necrotizing Scleritis

Episcleritis Circumscribed, usually segmental, and

generally nodular inflammation of the episclera (connective tissue between sclera and conjunctiva).

Epidemiology: Episcleritis is the most commonform of scleral inflammation.

Clinical appearance

Treatment : Topical NSAID Systemic NSAID to control pain Graft/ patch for threatening perforation

Prognosis : Episcleritis Self limiting, recurrent Scleritis recurrence high, perforation

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