Anatomy of Conjunctiva

Questions and Answers

Which antibiotic inhibits protein synthesis at the 50S ribosomal subunit?

Trimethoprim

Tobramycin

Polymyxin B

Azithromycin (correct)

What is the treatment duration recommended for Tobramycin or Gentamycin?

1 week

3-5 days (correct)

1 month

2 weeks

What category is AzaSite classified under?

D category

A category

C category

B category (correct)

Which of the following medications is specifically mentioned for suspected Heamophilus infection?

Fluoroquinolones Signup and view all the answers

What is the consequence of using Tobramycin/Gentamycin for a longer duration?

Risk of toxicity to the cornea Signup and view all the answers

If marked inflammation and a marginal infiltrate/ulcer are observed, which treatment is a second option?

Maxitrol Signup and view all the answers

How often should Zymar or Vigamox be administered for a suspected bacterial ulcer?

Every hour Signup and view all the answers

What is the follow-up time recommended after treatment for moderate to severe suspected Staph infection?

1 week Signup and view all the answers

What should be done if the condition worsens after initial treatment?

Start fluoroquinolones Signup and view all the answers

What is the primary function of the epithelium layer in the conjunctiva?

Acts as a protective barrier Signup and view all the answers

Which part of the conjunctiva connects the eyelids to the eyeball?

Palpebral conjunctiva Signup and view all the answers

Which arteries provide the blood supply to the conjunctiva?

Anterior ciliary and palpebral arteries Signup and view all the answers

The palpebral conjunctiva is associated with which area of the eyelid?

Entire eyelid margin Signup and view all the answers

What characterizes papillae found in conjunctivitis?

They are characterized by a vascular core surrounded by edema Signup and view all the answers

Which type of conjunctivitis is associated with follicles?

Viral conjunctivitis Signup and view all the answers

What type of conjunctiva lies loose over the underlying structures?

Bulbar conjunctiva Signup and view all the answers

What is the primary recommended treatment for mild conditions associated with severe itching and photophobia?

Cold compresses with topical antihistamines and mast cell inhibitors Signup and view all the answers

Which of the following contributes to sensory innervation of the superior palpebral conjunctiva?

Frontal and lacrimal branches of the ophthalmic nerve Signup and view all the answers

Which medication is recommended for treating moderate to severe papillary hypertrophy?

Lotemax 0.5% Signup and view all the answers

When dealing with a severe or resistant case, which of the following treatments might be added?

Oral steroids (Prednisone) Signup and view all the answers

What is the follow-up schedule recommended for moderate to severe cases after initial treatment?

Every 3 days Signup and view all the answers

In the case of a patient with a shield ulcer, which of the following treatments is NOT recommended?

Cold compresses Signup and view all the answers

What are the common oral antihistamines mentioned for treating allergic conjunctivitis?

Fexofenadine, Loratadine, Cetirizine Signup and view all the answers

Which condition is most likely associated with contact lens wearers?

Giant Papillary Conjunctivitis Signup and view all the answers

What is a possible acute treatment option during exacerbations of allergic conjunctivitis?

Mast cell stabilizer Signup and view all the answers

What should patients be cautioned about after using antihistamines for eye treatment?

Dryness of eyes Signup and view all the answers

In Giant Papillary Conjunctivitis, what indicates a late-stage symptom?

Giant papillae Signup and view all the answers

What is the recommended follow-up duration when treating with steroid nasal sprays?

5-7 days Signup and view all the answers

Which of the following is NOT a common treatment for chronic allergic conjunctivitis?

Long-term systemic antibiotics Signup and view all the answers

What type of hypersensitivity reactions are involved in Giant Papillary Conjunctivitis?

Type I and IV Signup and view all the answers

What is a recommended intervention for mild to moderate Giant Papillary Conjunctivitis?

Hydrogen peroxide systems for cleaning Signup and view all the answers

Which symptom is commonly associated with early-stage Giant Papillary Conjunctivitis?

Itching after lens removal Signup and view all the answers

What is the most common organism responsible for chronic bacterial conjunctivitis?

S.aureus Signup and view all the answers

Which symptom is specifically NOT associated with chronic bacterial conjunctivitis?

Severe eye pain Signup and view all the answers

What is an important treatment consideration for purulent eye conditions?

Immediate referral Signup and view all the answers

What is one of the suggested treatments for eyelid margin disease associated with chronic bacterial conjunctivitis?

Doxycycline Signup and view all the answers

What condition should be suspected in children with a history of sinusitis presenting swollen eyelids?

Bacterial conjunctivitis Signup and view all the answers

How often should hot compresses and lid scrubs be performed when treating eyelid margin disease?

Four times daily Signup and view all the answers

Which topical treatment should be used to manage chronic bacterial conjunctivitis?

Bacitracin ointment Signup and view all the answers

What additional medication may be added for managing meibomian gland dysfunction (MGD)?

Alodox at 20 mg BID Signup and view all the answers

What is the primary reason against using sulfa antibiotics in purulent infections?

Pus inhibits the activity of sulfa Signup and view all the answers

What is a common sign of chronic bacterial conjunctivitis?

Marginal corneal infiltrates Signup and view all the answers

Study Notes

Conjunctiva Anatomy

Composed of transparent mucous-like connective tissue, connecting eyelids to the eyeball.
Palpebral conjunctiva:
- Marginal conjunctiva extends ~2 mm from the lid margin, leads to the sulcus subtarsalis.
- Tarsal conjunctiva attaches to the whole tarsal plate in the upper lid; adheres to half the tarsus in the lower lid.
- Orbital part lies loosely between tarsal plate and fornix.
Forniceal conjunctiva:
- Joins bulbar conjunctiva with palpebral conjunctiva.
- Contains superior, inferior, medial, and lateral fornices.
- Caruncle: A small fleshy prominence (5x3 mm) at the nasal portion of the interpalpebral fissure, containing modified cutaneous tissue and accessory lacrimal glands.
Bulbar conjunctiva:
- Lies loosely over underlying structures, separated from the anterior sclera by Tenon’s capsule.
- Limbal conjunctiva forms a ridge around the cornea and is dense at the corneoscleral junction.

Histology

Epithelium: Acts as a protective barrier.
Adenoid Layer: Serves as a secretory portion.
Fibrous Layer: Functions as adhesive fibrous attachment.

Blood and Nerve Supply

Blood supply from the ophthalmic artery through anterior ciliary and palpebral arteries.
Sensory innervation:
- Superior palpebral conjunctiva: Frontal and lacrimal branches of the ophthalmic nerve (V1).
- Inferior palpebral conjunctiva: Lacrimal nerve and infraorbital branch of the maxillary nerve (V2).

Papillae and Follicles

Papillae:
- Inflammatory response with a vascular core; less than 1 mm size, common in allergic (upper) and bacterial (lower) conjunctivitis.
Follicles:
- Avascular, gelatinous, rounded nodules (~1 mm) found in tarsal conjunctiva; indicate viral or toxic conjunctivitis.
- Associated with lymphoid collections and resemble lymphoid follicles.

Chronic Conditions

Chronic Bacterial Conjunctivitis:
- Commonly caused by S.aureus; symptoms include redness, mucous discharge, and eyelid margin disease.
- Treatment includes bacitracin ung, lid scrubs, and addressing meibomian gland dysfunction.
Chronic Allergic Conjunctivitis:
- Variable acute signs; treatment focuses on maintaining therapy with artificial tears and antihistamines.

Giant Papillary Conjunctivitis

Primarily affects contact lens wearers; arises from hypersensitivity reactions.
Early symptoms include itching and hyperemia; late stage presents with intolerance to contact lenses and giant papillae.
Treatment involves stopping contact lens wear, cold compresses, and potentially topical antihistamines.

Important Treatment Considerations

Avoid sulfa antibiotics in cases of purulent conjunctivitis as pus deactivates their effectiveness.
Refer patients with suspected bacterial ulcers immediately.
Monitor patients with extensive symptoms or uncontrolled inflammation carefully and adjust treatment based on clinical response.

Other Treatment Options

For moderate to severe allergic responses, consider steroids and cyclosporine A for resistant cases.
Severe cases may require surgical interventions for papillary hypertrophy or shield ulcers.

Symptoms and Follow-up

Regular follow-up is crucial, typically within 3-7 days, to assess treatment efficacy and monitor for complications.

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Description

Explore the details of the conjunctiva, the transparent mucous-like connective tissue connecting the eyelids to the eyeball. This quiz covers its components like palpebral and tarsal conjunctiva, along with their anatomical significance.