ASIAN MEDICAL INSTITUTE , KANT KYRGYZSTAN

1. ASIAN MEDICAL INSTITUTE
NISHANT KUMAR.

2. The most common extraocular
disorder
Etiology:
infection of microorganism
physical injuries
chemical injuries
allergic disorder
immunological disorder
nutritional deficiency

3. According to the cause:
bacterial, chlamydial, viral,
fungal, allergic conjunctivitis
According to the course: acute,
subacute and chronic

4. Symptoms
• Foreign body sensation
• Scratching
• Burning
• Fullness around the eyes
• Itching and tearing
• pain and photophobia

5.  Hyperemia
 Tearing
 Exudation
 Pseudoptosis
 Papillary hypertrophy
 Chemosis
 Follicless
 Pseudomembranes
 Ligneous conjunctivitis
 Granulomas
 Phlyctenules
 Preauricular lymphadenopathy

6.  Hyperemia
 Hyperemia Ciliary flush

7.  Bacterial serous, mucous
and purulent
 Viral watery or serous
 Allergic one or xerophthalmia
ropy filamentous

10. papillary hyperplasia:
palpebral conjunctival epithelium
follicular formation:
accumulation of lymphocyte
beneath the conjunctival
epithelium

11. pseudomembrane or membrane : the
exudation rich in fibrin from
palpebral conjunctiva .
Pseudomembrane: in baby and
children, adenoviral, neonatal
inclusion, streptococcal conj.
True membrane: diphtheritic conj.

12.  Clinical examination
 Cytologic examination
smear of conjunctival and scaling
smear of conjunctiva
 Bacteriological examination
bacterial culture and drug sensitive
test
 Virus isolation and its antigenic
detection

13.  Remove pathogenic cause, take
local phamacotherapy as major,
systemic treatment as
supplement if necessary
 1)instillation of eyedrops
2)instillation of ointment
3)washing of conjunctival sac
4)systemic treatment
 Prevention

14. Hyperacute purulent conjunctivitis
with the strongest infectivity and large
destructibility
Etiology: diplococcus gonorrhoeae
adult: auto infection
children: touch infection
newborn: direct infection

15. Clinical findings
1)incubation period: 10h-2, 3d, acute onset
2)opthalmalgia, photophobia, tearing
3)swelling of the eyelids
palpebral and bulbar hyperemia and
chemosis
secretion: serous-bloody-purulent-nong lou
yan
inflammatory pseudomembrane
preauricular lymphadenectasis
corneal ulcer and perforation

16. Diagnosis:
clinical findings
lab examination(Gram’ stain, G- diplococcus)
Treatment:
topical and systemic one is the same
important
Prevention
be isolated to avoid infection and epidemic

17. Clinical finding:acute onset(1-3days),
both eye
tearing, foreign body and burning sensation
conjunctival hyperemia, purulent
secretion, palpebral swelling, spots of
subconjunctival hemorrhage
Ill process: 2 weeks

19. Etiology
bacterial infection:
acute-chronic or infection of
bacterial with weak toxicity
• non-infectious
environment factors: dust, chemical
smoke or gas and irritating eye drugs
• complicated from other disorders

20. Clinical finding:
chronic onset, both eye
itching, foreign body and asthenopia or
no symptoms
conjunctival hyperemia
mucous secretion
papillary and follicle hyperplasia
Treatment: give management
according to different causes

22. Chlamydin psittaci:
Chlamydia trachomatis:
antigen:ABCBa DEFGHIJK
trachoma genitourinary
system inclusion
conjunctivitis

23. Acute or subacute stage(1-2mon):
photophobia, tearing, foreign body
sensation
1)palpebral and bulbar conjunctival
hyperemia
2)ropy secretion
3)papillary hyperplasia, follicles
formation
4)corneal epithelitis
be cured without scar left

24.  Acute stage

25. Chronic stage: superinfections or
concomitant bacterial infections
1)Conjunctival hyperemia
2)ropy secretion
3)papillary hyperplasia, follicles
in upper fornix and palpebral
conjunctiva
conjunctival thickening
scar white luster like tenden
4)corneal epithelitis trachomatous
pannus

26.  Chronic stage

27. Our country Mac Callan’s
I Early stage of infiltration
hyperemia and
thickening
early follicle and corneal
panus
I progressive stage
papillae and follicles,
upper fornix is blurred,
corneal panus
II active stage
papillae and follicles,
corneal panus
II regressive stage
scar,a little active lesion
III precicatricial stage
III complete cicatricial stage IV cicatricial stage

28. Entropion and trichiasis
Blepharopatosis
Symblepharon (lower fornix)
Parenchymatous xerosis of
conjunctiva
Chronic dacryocystitis
Corneal pannus

29. 1)the vessels of upper fornix and
palpebral conjunctiva are blurred,
congested, papillary hyperplasia or
follicle formation or both
2)corneal pannus
3)scar
4)trachomatous inclusion
Diagnosis
on the basis of the first plus one of
other three
antigenic test

30. Scar corneal pannus

31. Topical tetracyclin,
erythromycin
Systemic sulfadiazine
rifampin
Operative: sequelae and
complication

32. Acute onset, strong infectivity,
may be sporadic or epidemic
Etiology: adenovirus, type 8,
19, 29 and 37.

33. Clinical findings:
1)incubation period: 5-7d.
2)foreign body sensation, itching, pain,
photophopia and tearing
3)palpebral edema, conjunctival
hyperemia and chemosis, less and
watery secretion, follicles in palpebral
and fornix conjunctiva, preauricular
lymphadeectasis and tenderness
4)be cured after one week
exacerbate: superfial punctate keratitis

34. Diagnosis:
Acute folliclar cinjunctivitis
superfial punctate keratitis
preauricular lymphadenectasis
neutrophial
Treatment: no specific drug
1)antiviral:topical(mainly) and systemic-
acyclic
2)antibiotic

35. Fulminant epidemic ocular
infections
Etiology:
entero-virus type 70,
picornavirus
Coxsackie virus type A 24

36. Clinical findings:
1)incubation period: 24hr
2)ill course: self-limited, 10d or shorter
3)ophthalmagia, foreign body sensation,
photophopia and tears
4)eyelid and conjunctiva red and swollen,
watery secretion, follicular hyperplasis of
palpebral conjunctiva, patchy hemorrhage on
bulbar conjunctiva, preauricular
lymphadenectasis
5) Transient fine punctate epithelial keratitis

37. Symptom:extreme itching
Sign
1)palpebral type:
papillary hyperplasia in the upper
palpebral conjunctiva that like oval
flat cobblestone, eosinophillia in
secretion
2)corneal limbal type:
collid tubercles at the corneal
limbus
3)mixed type:

39. Treatment:
1)self-limited, no vision
affected
2)general treatment:
keep away proble sensitinogen
3)medical treatment:
natrii cromoglycas
corticosteroid

40. Immediated allergic antigen:
pollen, contact lens, etc.
Delayed one: various drug
Clinical findings:
immediate type: dermatitis
of palpebral skin, blepharitis,
mild infiltrative conjunctivitis

41. Lab examination:
degenerative epithelial cell, few
polynuclear cells and mononuclear
cells in secretion
Treatment:
1)find out and get rid of sensitinogen
2)corticosteroid
3)3% boric solution
4)anti-allergic agents

42. Etiology: delayed reaction to
protein of microorganism,
mostly to mycobecterium
tuberculosis and staphylococcus
aureus
Clinical findings: herpetic
tubercle may appear on the
bulbar conjunctiva or limbus.

43. Etiology: unclear, outdoor work
Clinical findings:
1)hypertrophic bular conjunctiva and
its subconjunctival tissue invade onto
the cornea with the shape of tiangle
2)composed of head, neck, body.
3)progressive, stationary
4)differentiated with pseudopterygium
Treatment: operation

44. A degenerative lesion of the
bulbar conjunctiva caused by
the effect of ultraviolet rays
Clinical findings:
a kind of white–yellow
amorphous subepithelial
deposition near to the limbus
Treatment: no needed

45.  Pterygium Pingueculae

46.  Concrement on the palpebral
conjunctiva
 Old or those with chronic
conjunctivitis
 White-yellow deposit
 Treatment:
no need
be rejected

47. nevi
Dermolipoma
angioma

48. Squamous Malignant
cell carcinoma melanoma

49.  Caused by vascular rupture beneath
the bulbar conjunctiva or by osmotic
increase of vascular wall
 Treatment:
1)find out the cause
2)good explanation