Conjunctiva

The conjunctiva (the outermost layer covering the white portion of the eye) is the most common site for external eye diseases since it is exposed to all types of exogenous irritants & infections and hence also prone to allergic reactions. The conjunctiva is also never free from organisms but the overlying tearfilm washes them away.

Simple hyperemia (redness) of the conjunctiva

Can be acute (transitory), recurrent or chronic.
Acute red eye can be caused by temporary irritation, such as Foreign body, any ingrowing lash, acute conjunctivitis, causes other than conjunctival ( iritis, acute congestive glaucoma) etc.,
Recurrent or chronic redness can be caused by dusty surroundings, exposure to heat, allergic reaction such as hay fever etc.,

Symptoms

Ocular discomfort, tightness, grittiness, watering, tiredness or inability to keep eyes open.

Treatment

Treatment of the cause / symptomatic

Inflammation of the conjunctiva

1. Infective
2. Allergic

Infective Conjunctivitis (Acute Mucopurulent Conjunctivitis)

Symptoms

Redness, Gritty sensation, Watering, mucopus discharge, Swelling of the eye lids, Coloured haloes etc.,

Causes

1. Bacterial.
2. Source of organisms is mainly the nose, genitals etc.,

Staphylococcus: Associated with blepharitis (infection of the eye lashes), eczema of the skin etc., Frequently associated with corneal involvement. The usual source of organisms is the nose

H.Aegyptius: Can give rise to widespread epidemics particularly in sandy, semitropical countries. Often associated with severe corneal involvement. Contact transmission is common.

Pneumococcus: Causes more conjunctival swelling and inflammation and forms membraneous films (pseudo membrane). Can involve cornea and produce hypopyon corneal ulcer.

Gonococcus: It is acute, direct infection from genitals, occurring usually in males and in the right eye. It causes severe swelling of eyelids & conjunctiva, great pain, copious purulent discharge, marked tendency to involve the cornea, membranous films over conjunctiva, enlarged, tender and suppurative preauricular lymph notes. Has association with urethritis and can involve the other eye. Can also cause corneal ulcers.

Treatment

Control of infection by appropriate medications (both topical and systemic) Since it is a very contagious disease, care must be taken to prevent its spread to the other eye and among others. The patient must keep his hands clean and no one else must be allowed to use his towel, handkerchief etc.,

Ophthalmia neonatorum

Preventable disease occurring in new born children due to maternal infection acquired during delivery through the birth passage. It used to be an important cause of blindness in children but recently decline in incidence of gonorrhoea as well as effective methods of prophylaxis and treatment have almost eliminated its occurrence in our country.

Even then, any discharge, even a watery secretion, from a baby's eyes during the 1st week of birth should be viewed with suspicion.

Symptoms and Signs

1. Mucopurulent / Purulent discharge.
2. Both eyes bright red, swollen with thick yellow pus.
3. Untreated disease can cause corneal ulcer and perforation

Treatment

1. Prophylaxis : 1% Silver nitrate.
2. Vigorous treatment with Antibiotics.

Chronic Conjunctivitis

Can occur as a continuation of simple acute conjunctivitis or in the presence of a continuous irritant - smoke, dust, bad air, late hours ( e.g., Computer professionals ) etc., misplaced lashes, dacrocystitis (infection of the tear gland) chornic rhinitis etc.,

Viral Conjunctivitis

Generally associated with fever, pharyngitis, preauricular lymphadenopathy, especially in children in epidemic forms.
Sometimes corneal complications can occur.
It is markedly contagious, with watery discharge and conjunctival haemorrhages, occurs in wide spread epidemics and spreads through contaminated tear secretions, fingers etc.,

Allergic Conjunctivitis

Acute allergic catarrhal conjunctivitis

Allergic Conjunctivitis is a chronic condition with marked tendency to acute / subacute exacerbations on renewed contact with the allergen.
Contact with animals (eg., Cats) pollens, dusts, chemicals, some types of eye drops, cosmetic and eye liners etc., can all cause allergic eye reactions in susceptible individuals.

Treatment

Removal of allergen, anti histaminics, mastcell stabilizers, low efficacy steroids etc.,

Vernal Catarrh / Seasonal Allergic conjunctivitis

It is a recurrent bilateral conjunctivitis occurring with amset of hot weather, found in young people, usually boys. Associated with burning, itching, photophobia, watering, characteristic white, ropy secretion. The condition subsides during cooler months. It is non contagious, associated with asthma, eczema of the skin etc.,

Treatment

Symptomatic

Even after the acute irritation subsides, a maintenance dose during the seasonal period of activity generally keeps the symptoms in check.

Traumatic Chemical Conjunctivitis

Burns by hot water, steam, exploding powder or molten metal, injuries by caustics such as lime usually from whitewash, or strong acids and alkalis may produce considerable damage by involving the cornea and conjunctiva.

Apart from the severe corneal complications, the conjunctiva itself can get severely congested and chemosed, and can produce permanent adhesions between the lid and the globe as a late complication unless vigorously treated early. This once produced impedes the movements of the globe and every precaution must be adopted to prevent its occurrence.

Treatment

Excess of deleterious material must be removed at the earliest possible moment. Copious irrigation with water is a must and all material possible should be removed perseveringly. Medications have to be used depending on extent of damage.

Conjunctival degenerations

Pingecula

Triangular patch on conjunctiva found usually in elder people, especially those exposed to strong sun light, dust, wind, etc., Can cause symptoms like pain, irritation when it gets inflamed

Pteriygium

Degenerative condition of the subconjunctival tissue proliferating and invading over cornea destroying its superficial layers. Appears as a triangular encroachment over the conjunctiva with its apex towards cornea. Can impair vision if it progresses into the pupillary area of the cornea. This condition is more common in sunny climates. Has to be removed if it is encroaching over cornea or for cosmetic reasons.

Sub Conjunctival haemorrhage

It is mostly the result of injury due to rupture of small vessels of the conjunctiva. Can occur spontaneously, after severe straining, lifting heavy weights, vomiting etc., Can occur as result of fracture of the base of the skull in severe cases where the haemorrhage seeps forward from the fornix due to extravasation of blood along the floor of the orbit.

Xerophthalmia

It is a dry, lusterless condition of the conjunctiva which occurs mostly because of a deficiency of vitamin A in the diet and occurs usually in children accompanied by night blindness. Mostly occurs in marasmic, malnourished children. Can lead to severe necrosis of cornea in neglected cases.