NON INFECTIOUS COJUNCTIVITIS

heera tharanendran

ETIOLOGY
ALLERGIC y IRRITANTS(physical,foreign bodies,radiation,contact lens use) y ENDOGENOUS OR AUTOIMMUNE y DRY EYE y TOXIC(chemical or drug induced) y IDIOPATHIC
y

ALLERGIC CONJUNCTIVITIS
VERNAL /SPRING CATARRH CATARRHAL PHLYCTENULAR (Eczematous)

EXOGENOUS ALLERGENS

ACUTE/ SUB ACUTE

ENDOGENOUS ALLERGENS

Acute or sub acute catarrhal conjunctivitis

Definition:acute or sub acute non specific urticarial reaction to allergen. y Etiology: y Endogenous allergen-protein of S.aureus in nose ,URT. y Exogenous allergen-pollens, flowers, contact with animals(horse,cat). y Chemicals,cosmetics,eyelash dyes y Drug-atropine
y

Symptoms
y y y

Signs
y y y

Itching Watery secretion Marked redness of the conjunctiva

Congestion with multiple follicles Watery mucoid discharge Skin of lid red,swollen

DIFFERENTIAL DIAGNOSIS
CLINICAL FEATURES HYPERAEMIA BACTERIAL MARKED ALLERGIC LESS MARKED

EXUDATE

PURULENT/ MUCOPURULENT LESS

ROPY WHITE

EOSINOPHILS

MORE

TREATMENT
Removal of the allergen y Astringent lotions y Adrenaline solutions y Antihistamine drugs(1%Antistine privine,chlorpheneramine) y Mast cell stabilizers(sodium cromoglycate,ketotifen) y Corticosteroid drops
y

VERNAL CONJUNCTIVITIS
y

DEFINITION:Recurrent,bilateral,seasonal conjunctivitis occurs with onset of hot weather.

ETIOLOGY: y Exogenous allergens y Hypersensitivity reaction y Mediated by IgE y Accompanying EOSINOPHILIA

y

SYMPTOMS
y y y y y

Burning Itching Discomfort in bright light (photophobia) Lacrimation White ropy secretion

TYPES
mixed

Palpebral form

Limbal/bulbar form

Palpebral form
Conjunctival hyperaemia and chemosis. y Papillary hypertrophy y Palpebral part shows multiple polygonal shaped nodules-cobblestones y Color-milky white due to thickened epithelium y Eosinophils increased.
y

Bulbar form
Opacification - limbus y Multiple nodules or wall of gelatinous thickening limbus. y Horner-Trantas dots discrete chalky white superficial spots.
y

Complications-Keratopathy ComplicationsMainly due to corneal involvement y Buckley Classification- 5 clinical stages: 1. Superficial punctate keratitis 2. Epithelial macro erosion and ulceration 3. Plaque 4. Ring scar 5. Pseudogeron toxon
y

PUNCTATE EPITHELIOPATHY

MACROEROSION

CORNEAL PLAQUE

SUBEPITHELIAL SCARRING

PSEUDOGERONTOXON

Differential diagnosis
FEATURES AGE SPRING CATARRH YOUNG(6-20Yrs) TRACHOMA ALL AGE UPPER LID AND UPPER FORNIX IRREGULAR MUCOPURULENT LEBERS CELLS NONE NONE

SITE OF PALPEBRAL-UPPER LID FOLLICLE/PAPILLAE LIMBAL-BULBAR CONJUNCTIVA ARRANGEMENT DISCHARGE CONJUNCTIVAL SCRAPING SEASONAL VARIATION ITCHING COBBLE STONE THICK,ROPY/STRINGY EOSINOPHILS SUMMER,SPRING MARKED

TREATMENT

Topical steroids Mast cell stabilizers Acetylcysteine Cold compresses,tinted glasses

GIANT PAPILLARY CONJUNCTIVITIS Definition : Specific allergic inflammation affecting the superior tarsal conjunctiva y Etiology : y soft contact lens wearers y post operative protruding sutures y ocular prostheses
y

SYMPTOMS
y y y

SIGNS
y

Itching Irritation Increased mucus production

Upper palpebral conjunctiva shows giant papillae

TREATMENT
y y y y y

Discontinue or change type of contact lens Remove offending sutures Clean and polish occular prosthesis Mast cell stabilizer with artificial tears,antihistaminic drops,decongesants Topical steroids Supratarsal injection of steroid

Phlyctenular conjunctivitis
DEFINITION: Allergic reaction of the conjunctiva caused by endogenous proteins characterised by formation of bleb or nodule near the limbus. y ETIOLOGY: y Caused by allergic reaction to endogenous bacterial protein such as tuberculosis.
y

Symptoms
Discomfort y Irritation y Itching y Reflex lacrimation
y

Signs
Nodules-bulbar conjunctiva near the limbus Congestion

Clinical types
1. 2. 3.

Phlyctenular conjunctivitis Phlyctenular Kerato-conjunctivitis Phlyctenular keratitis

Ulcerative phlyctenular keratitis

Diffuse infiltrative phlyctenular keratitis

DIFFERENTIAL DIAGNOSIS
FEATURES AGE NODULE MOBILITY SITUATION TENDERNESS ULCERATION PHLYCTEN CHILDREN GREY/YELLOW MOVABLE AT THE LIMBUS NO YES EPISCLERITIS ADULTS-WOMEN PINKISH RED IMMOVABLE TEMPORAL SIDE AWAY FROM THE LIMBUS YES NO

Treatment
Corticosteroids y Antibiotic y Atropine y Dark glasses /eyeshade

SUMMARY
CATARRHAL-Ropy white exudate eosinophilia y VERNAL-exogenous allergen Palpebral-Cobblestone Bulbar-Horner trantas dots y PHLYCTENULAR-endogenous allergen Bleb near limbus
y

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