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Pinguecula - An overview

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Pinguecula - An overview

  1. 1. PINGUECULA Indra PSharma Optometrist, Bhutan
  2. 2. Objective IPS 2  To have a better understanding about pinguecula with regard to its pathophysiology, clinical manifestation, management and prevention.
  3. 3. Contents IPS 3 1. Overview of pinguecula 2. Pathophysiology 3. Etiology 4. Clinical features and differential diagnosis 5. Treatment 6. Possible complication 7. Culprit in CL practice 8. Prevention 9. Conclusion 10. References
  4. 4. Introduction IPS 4  Common degenerative condition of the conjunctiva.  Yellowish white patch on the bulbar conjunctiva.  Derived from pinguis (meaning fat )  Considered a precursor of pterygium
  5. 5. IPS 5 Typical pinguecula
  6. 6. Characteristics IPS 6  Presents as yellowish white patch near limbus.  Usually affects the nasal side first and then the temporal side.  When conjunctiva is congested, it stands out as an avascular prominence.  Calcification occurs occasionally.  Remain stationary or may enlarge gradually over long periods of time.
  7. 7. ICDCode  International Classification of Disease (ICD) code for Pinguecula  ICD-10 : H11.1  ICD-9 : 372.51 Sharma IP
  8. 8. Epidemiology  Male: female= 2:1  Most common over the age of 40  But may occur in 20 and 30 years old adults who spend significant time in the sun.  May have an increased prevalence in Gaucher's disease. IPS 8
  9. 9. Pathology IPS 9  Elastotic degenerationo f collagen fibres of the substantia propria of conjunctiva  Plus deposition of amorphous hyaline material in the substance of conjunctiva.  Histologically it shows degeneration of the collagen fibers of the conjunctiva stroma with thinning of the overlying epithelium and occasional calcification
  10. 10. Etiology IPS 10  Etiologyis not knownexactly.
  11. 11. Contd.. IPS 11  UV radiation is thought to be main trigger factor.  Therefore, the incidence is much higher in equatorial countries
  12. 12. Contd.. IPS 12 Incidence is much higher in equatorial countries More in those who are usually outdoor
  13. 13. Contd... IPS 13  Figure : The UV radiation affects the temporal area and travels through the cornea to the nasal area, where the UV power increases up to 20 times more.
  14. 14. Contd... IPS 14  Insults such as welding.  Dust and wind.
  15. 15. Clinical features IPS 15 Symptoms  Usually asymptomatic  Ocular irritation and discomfort  Aesthetic concerns  Recurrent inflammation
  16. 16. IPS 16 Signs  Appearance of yellow-white, amorphous subepithelial deposits epithelium.  Appear adjacent to the limbus in the interpalpebral zone, more often nasally.  Conjunctiva overlying a pinguecula may be normal, thick, or thin.
  17. 17. IPS 17
  18. 18. Differential diagnosis  Squamous Cell Carcinoma  Bitots spot  Phlectenule IPS 18
  19. 19. Examination and diagnosis  Obvious clinical diagnosis IPS 19
  20. 20. IPS 20 No treatment required Treatment
  21. 21. Contd.. IPS 21  Lubricant to alleviate ocularirritation
  22. 22. IPS 22 Excision indicated when pinguecula  Cause cosmetic problems  become chronically inflamed(pingueculitis)  interfere with successful contact lens wear. Contd..
  23. 23. Contd...  In a study (July 2013) removal of pingueculae with a laser vs. traditional surgical excision was compared.  Researchers found  Eyes treated with argon laser photocoagulation- (90.5 %) complete removal of pingueculae  Eyes treated with traditional surgical excision - (63.9 %) complete removal IPS 23
  24. 24. IPS 24 Weaktopical steroids  Judicious use of weak topical steroids may be considered in patients with chronic inflammation. Eg. Gtt. Fluorometholone tds reducing over 3 weeks.  But they are strongly discouraged as a chronic therapy due to their side effects Contd..
  25. 25. Complication IPS 25  Rarecomplication  inflammation, intraepithelial abscess formation  rarely conversion into pterygium
  26. 26. Prognosis  Visual and cosmetic prognosis is good.  Vision is not affected.  No systemic and genetic association noted. IPS 26
  27. 27. The culprit in CL practise  A common scleral obstrucle in CL practise.  Small pinguecula doesnt cause problem.  However larger can cause decentration of contact lens. IPS 27
  28. 28. Contd IPS 28  The firm nature of scleral GPs can cause patients significant irritation if the lens edge bumps into the pinguecula, or their rigidness will prevent an acceptable fit if an elevated pinguecula lies beneath the haptic.  In such cases, we consider a corneal GP, soft specialty design, or hybrid design. Alternatively, a notch can be beveled out of a scleral lens, which will allow it to bypass the pinguecula.
  29. 29. IPS 29  Aviod eye irritants Prevention
  30. 30. IPS 30  Good quality Sunglasses  Hats and caps Contd...
  31. 31. Conclusion IPS 31  Pingucula is a common disease.  Lubrication is the mainstray treatment.  Most cases can be managed by optometrist.  Some special attention may be required in contact lens practise.
  32. 32. Reference IPS 32 Books andjournals  American Academy of Ophthalmology, External DiseaseandCornea ,Section 8 (2011-2012), 12: 331-332  Kamel S. Thepterygium: its etiologyandtreatment. Am J Ophthalmology, 1954;152(5):733-8  Kanski Jack J, Clinical Ophthalmology- Asystemic approach, 6th Ed, Butterworth Heineman Elsevier. 8: 242  Jackson Timothy L, MoorfieldMannual of Ophthalmology, Mosby Elsevier, 4:137 Websites:  http://pterigion.net/2012/09/03/pterygium-what-is-it-how-is-it-treated/ retrieved on 1/2/2015  http://www.nytimes.com/health/guides/disease/pinguecula/overview.html retrieved on 1/2/2015  http://www.clspectrum.com/articleviewer.aspx?articleID=107286 retrieved on 1/2/2105  http://en.wikipedia.org/wiki/Pinguecula retrieved on 1/2/2105
  33. 33. IPS 33
  34. 34. Questions?  What are the causes of pinguecula?  Why is the prevelance of pinguecula more in male?  What is the optometric management of pinguecula?  What are the indication for pinguecula excision? IPS 34
  35. 35. Tashi Delek Sharma IP

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