4. 1. SIMPLE ALLERIC CONJUNCTIVITIS
MILD non specific allergic conjunctivitis
Characterised by
Itching
Hyperaemia
Mild papillary response
5. IT IS SEEN IN FOLLOWING FORMS
1.HAY FEVER CONJUNCTIVITIS
ASSOCIATED WITH HAY FEVER
COMMON ALLERGENS:POLLENS,GRASS,ANIMAL DANDRUFF
2.SEASONAL ALLERGIC
CONJUNCTIVITIS
RESPOSE TO SEASONAL ALLERGENS SUCH AS GRASS POLLENS
3.PERENNIAL ALLERIC
CONJUNCTIVITIS
RESPONSE TO PERENNIAL ALLERGENS SUCH AS HOUSE DUST AND MITES
6. 1.VASCULAR RESPONSE
EXTREME VASODILATION AND INCRESED
PERMEABILITY OF VESSELS LEADING TO
EXUDATION
2.CELLULAR RESPONSE
CONJUNCTIVAL INFILTRATION AND
EXUDATION IN THE DISCHARGE OF
EOSINOPHILS,PLASMA CELLS,MAST CELLS
PRODUCING HISTAMINES AND HISTAMINE
LIKE SUBSTANCES
3.CONJUNCTIVAL RESPONSE
BOGGY SWELLING OF CONJUNCTIVA
FOLLOWED BY INCREASED CONNECTIVE
TISSUE FORMATION AND MILD PAPILLARY
HYPERPLASIA
10. ETIOPATHOGENESIS
PATHOLOGY
Conjunctival epithelium undergoes
hyperplasia send downward projection into
the subepithelial tissue
Adenoid layer shows marked cellular
infiltration
Fibrous layer shows proliferation which later
on undergoes hyaline change
Conjunctival vessels also shows
proliferation,increased permeability and
vasodilatation
11. CLINICAL PICTURE
SYMPTOMS SIGNS
1.PALPEBRAL FORM
Upper tarsal conjunctiva of both
eyes is involved
TYPICAL LESION:presence of
hard,flat topped,papillae
arranged in’COBBLE STONE’or
‘PAVEMENT STONE’fashion
Conjunctival changes associated
with white ropy discharge
2.BULBAR FORM
• Dusky red triangular
congestion of bulbar
conjunctiva in palpebral area
14. C.Treatment of large papillae
• Supratarsal injection of long acting steroids
• Cryo application
• Surgical excision is recommended for extra ordinary large papillae
D.General measures
• Dark goggles to prevent photophobia
• Cold compresses and Ice packs have soothing effects
• Change of place from hot to cold areas
E.Desensitization
21. TREATMENT
THE OFFENDING CAUSE SHOULD BE REMOVED After
discontinuation of contact lens or artificial eye or removal of
nylon sutures,the papillae resolve over a period of one month
DISODIUM CROMOGLYCATE relive the symptoms and enhance
rate of resolution
STEROIDS are not of much use
23. ETIOLOGY
1.CAUSATIVE ALLERGENS
o Tuberculous proteins
o Staphylococcus proteins
o Other allergens:protein of Moraxella
Axenfeld bacillus and certain parasites
2.PREDISPOSING FACTORS
a) Age:Peak age group 3-15yrs
b) Sex:incidence higher in girls
c) Undernourishment
d) Living condition:over crowded and
unhygienic
e) Season:incidence high in Spring and
Summer
24. PATHOLOGY
1.STAGE OF NODULE FORMATION
Exudation and infiltration of leucocytes
into deeper layers of conjunctiva leading
to nodule formation
Central cells are polymorphonuclear and
peripheral cells are lymphocytes
Neighbouring blood vessels dilate and
their endothelium proliferates
2.STAGE OF ULCERATION
Necrosis occurs at apex of nodule and an
ulcer is formed
Leucocyte infiltration increases with
plasma and mast cells
3.STAGE OF GRANULATION
Floor of ulcer becomes covered by
granulation tissue
4.STAGE OF HEALING
Healing with minimal scarring
25. CLINICAL PICTURE
SYMPTOMS
Mild discomfort in the eye
Irritation
Reflex watering
Mucopurulent conjunctivitis due to secondary
bacterial infection
SIGNS
1.SIMPLE PHLYCTENULAR CONJUNCTIVITIS
Characterised by:
• presence of typical pinkish white nodule
surrounded by hyperaemia on the bulbar
conjunctiva,near limbus
• In a few days nodules ulcerate at apex which
later on gets epithelized
2.NECROTISING PHLYCTENULAR
CONJUNCTIVITIS
Characterised by:
• Presence of large phlycten with necrosis and
ulceration leading to a severe pustular conjunctivitis
3.MILIARY PHLYCTENULAR CONJUNCTIVITIS
Characterised by:
• Presence of multiple phlyctens arranged
haphazardly or in form of a ring around limbus and
may even form ring ulcer
26. DIFFERENTIAL DIAGNOSIS
Phlyctenullar conjunctivitis needs to be differentiated from the
episcleritis,scleritis and conjunctival foreign body
granuloma
Presence of one or more whitish raised nodules on the bulbar
conjunctiva near the limbus with hyperaemia usually of surrounding
conjunctiva,in a child living in bad hygienic conditions are
diagnostic features of phlyctenular conjunctivitis
27. MANAGEMENT
1.LOCAL THERAPY 2.SPECIFIC THERAPY
Attempt must be made to search and
eradicate following causative conditions:
i. TUBERCULOUS infection should be
excluded by chest X-ray,Mantoux
test,TLC,DLC,and ESR.
ii. SEPTIC FOCUS in the form of
tonsillitis,adenoiditis,or caries teeth
when present should be adequately
treated by systemic antibiotics and
necessary surgical measures
iii. PARASITIC INFESTATION should be
ruled out byrepeated stool
examination
3.GENERAL MEASURES
30. CLINICAL PICTURE AND DIAGNOSIS
CLINICAL PICTURE
CUTANEOUSINVOLVEMENTisintheformof
weepingeczematousreaction,involvingallareas
withwhichmedicationcomesincontact
CONJUNCTIVALRESPONSEisintheformof
hyperaemiawithgeneralizedpapillaryresponse
affectingthelowerfornixandlowerpalpebral
conjunctivamorethantheupper
DIAGNOSIS is made from
Typicalclinicalpicture
Conjunctivalcytologyshowsalymphocytic
responsewithmassesofeosinophils
Skintesttothecausativeallergenispositivein
mostofthecases
31. TREATMENT
1. Discontinuation of the causative medication
2. Topical steroid eye drops to relieve symptoms
3. Application of steroid ointment on the involved skin
