Conjunctiva
Cornea
T h e s e c o n d a ff i l i a t e d h o s p i t a l o f N a n c h a n g u n i v e r s i t y
Mao Xin Bang 毛新帮
Conjunctiva
t h e s e c o n d a ff i l i a t e d h o s p i t a l o f N a n c h a n g u n i v e r s i t y
Mao Xin Bang 毛新帮
Review ： Anatomy and
Physiology
Palpebral （睑结膜）
Bulbar （球结膜）
Fornices （穹窿部） : the
folds uniting the
palpebral and bulbar
portion
Diseases of the conjunctiva
Conjunctivitis （炎症） ---the common disease in
ophthalmic out-patient
Degenerative Changes in the Conjunctiva （变性）
Cysts and Tumours （囊肿和肿瘤）
Dry Eye （干眼） --- close relation to the cornea and teal film
1 、 Clinical Features of Conjunctival Disorders
1.1 hyperaemia （充血）
Localized mild serious
1.2 discharge （分泌物）
watery mucopurulent （粘脓性） purulent （脓性）
1.3 Subconjunctival haemorrhage （结膜下出血）
1.4 chemosis （结膜水肿） 1.5 follicles （滤泡）
1.6 papillary hypertrophy （乳头增生）
small giant
1.7 pseudomembranes and membranes （假膜和膜）
pseudomembrane membrane
2. Conjunctivitis
Classification:
onset
Type of exudate
bacterial
Conjunctival response
viral
aetiology
infectious chlamydial （衣原体）
fungal （真菌）
parasitic （寄生虫）
Non-infectious Allergic/irritants/endogenous
2.1 Conjunctivitis Due to infections
2.1.1 bacterial conjunctivitis
Milder cases Severe cases Particularly severe cases
hyperaemia milder “pink eye”/congested severe
discharge mucous mucopurulent Copious （大量的） purulent
other Gum （粘合） the lids matting the lashes （睫毛定型） pain/tender/lid
features together,particularly together with dirty yellow swelling/preauricular lymph
in the morning crusts （壳） /coloured halos enlarged （耳前淋巴结肿大）
（环）
bacterial conjunctivitis treatment
Keep hands clean/no one else should be allowed to use his towel,Handkerchief,
pillow and so on.
Antibiotic drops (chloramphenicol/lomefloxiacin) 4-6 times a day
Antibiotic ointment （药膏 ） at bedtime
Should not be bandaged
Should not be used topical steroid drops
2.1.2 viruses conjunctivitis
epidemic herpes simplex Haemorrhagic
keratoconjunctivitis conjunctivitis conjunctivitis
viruses conjunctivitis
epidemic herpes simplex Haemorrhagic
keratoconjunctivitis conjunctivitis conjunctivitis
causative organism Adenovirus 腺病毒 HSV type 1 for majority Enterovirus 肠道病毒
types 8,19,3and 7 HSV type 2 for newborns type 70
Involved eye Both eyes Both eyes
Single eye
Redness/ temporary irritation /pain/ foreign body
symptom
/lacrimationliu 流泪 /photophobia / tiredness
sign 1 Hyperaemia/ chemosis/ lid swelling
Vesicles on the skin subconjunctivitis haemorrhage
sign 2 preauricular 耳前 erqianlymph enlarged and tenderness
Complication: Subepithelial opacities Dendrities keratitis Epithelial keratitis
Cornea involved in the central cornea 树枝
course of disease 3-4weeks 2-3weeks 5-7days
viruses conjunctivitis treatment
Self-limited , generally,there is no specific therapy
antiviral therapy topically or systemically to prevent the cornea
involvement
Antibiotic drops for bacterial superinfection
Usually,topical steroid drops should not be used
2.1.3 Chlamydial （衣原体） conjunctivitis
• Cause of Chronic follicular conjunctivitis （慢性滤
泡性结膜炎）
• Three clinical syndromes
a)Trachoma （沙眼）
b)Adult inclusion conjunctivitis （承认包涵性结膜
炎）
c)Neonatal conjunctivitis （新生儿结膜炎）
Phases of Trachoma （沙眼） WHO grading of Trachoma
• TF ： trachoma follicles with 5 or more on
•Follicular Trachoma the superior tarsus （上睑）
•Inflammatory Trachoma • TI ： trachomatous inflammation diffusely
involving tarsal conjunctiva 结膜跗骨 which
•Trachomatous scarring （沙眼瘢 obscures 50% or more of normal deep tarsall
vessels
痕） • TS ： trachomatous conjunctival scarring
•Trichiasis （倒睫） • TT ： trachomatous trichiasis 倒睫 touching
cornea
•Corneal opacities （角膜混浊） • CO ： corneal opacity
Trachoma treatment
• Medical
Oral Azithromycin 阿奇霉素
Oral tetracyclin 四环素
Oral erythromycin 红霉素
Topical tetracyclin or erythromycin 红霉素
• Surgical
Full-thickness incision of the scarred lid and the use of
rotation sutures.
Correction of inturned eyelashes 睫毛 .
2.2 Allergic disorders
2.2.1 Allergic conjunctivitis(AC) or 鼻结膜炎
rhinoconjunctivitis
Acute allergic conjunctivitis
seasonal or hay feverhay fever
toxic -induced by acute contact with irritants,
drugs,preservatives 防腐剂 , etc)
Chronic allergic conjunctivitis
perennial （复发性的） induced by non-seasonal allergens, dust
mites and fungal allergens 过敏原 , less prevalent and milder
but more persistent)
toxic-induced
2.2.2 Giant papillary 2.2.3. Vernal keratoconjunctivitis (VKC)
conjunctivitis(GPC) palpebral 、 limbal 、 mixed
Treatment Treatment
Discontinue CL wear Topical steroid
Improving lens hygiene 卫生 Mast cell stabilizers 肥大细胞稳定剂
Discarding or refitting 重新拟合 , daily Topical cyclosporine 环孢素
wear, disposable CL Antihistamine 抗组胺药
Topical steroid ,mast-cell stabilizer Supratarsal 上睑板 injection of
steroidexplanation
cornea 角膜病
t h e s e c o n d a ff i l i a t e d h o s p i t a l o f N a n c h a n g u n i v e r s i t y
Mao xin bang 毛新帮
review ： Anatomy 、 histology and physiology
of the cornea
transparency
no blood vessel
the front of the eyewindow
Corneal anatomy 、 histology
refractive media
cornea physiology
blood s upply ：
nerve supply ： anterior ciliary nerv es
lose their myelin sheath 髓鞘
funciton: major refracting medium
protect intraoc ular c ontents
source of nutrients : solutes
Ox ygen
rich Metabolism
nerve
corneal limbal stem cell
immune exemptiom
pump
1 、 introduction
●keratopathy ： main cause of
blindness
●cornea disease:
inflammation
trauma
degeneration
dystrophy
tumor
●corneal inflammation ： first cause
2 、 corneal inflammation
Etiology 病因学：
● Bacterial 、 Fungal
● Herpes simplex virus 、 acanthamoeba 棘阿米巴
● Symptoms
● Red eye, mild-to-severe ocular pain
● photophobia, decreased vision
Critical Signs
● Focal white opacity in the corneal stroma
(infiltrate).
● An ulcer exists if there is an overlying
epithelial defect that stains with fluorescein.
2.1 Pathological process -
1
corneal restores to clear
---repair 、 heal 、 scar left
---corneal nebula 云翳
---corneal macula 斑翳
---corneal leukoma 白斑
---Corneal neovascularization
2.1 pathological process-2
corneal ulcer
--- ulcer perforates 穿透
--- bacteria enter the eye
--- endophthalmitis
2.1 pathological process-3
corneal ulcer
--- ulcer perforates
--- anterior synechia 粘连 of iris
--- corneal anteria adhisive/leuvoma/staphyloma
--- second glaucoma
Bacterial keratitis
Etiology ：
Most common infectious etiology.
In general, corneal infections are assumed to be bacterial
until proven otherwise by laboratory studies
a therapeutic trial is unsuccessful.
2.2 Bacterial keratitis
Signs ：
Conjunctival infection
corneal thinning, stromal edema and inflammation
surrounding the infiltrate （ , folds in Descemet's membrane,
anterior-chamber reaction, hypopyon, mucopurulent
discharge, upper eyelid edema.
Posterior synechiae （粘连） , hyphema （前房积血） , and glaucoma
may occur in severe cases.
laboratory studies
gram-positive bacteria
Gram-negative bacterial
(Pseudomonas aeruginosa)
Circular or elliptical foci （椭圆焦
Rapid progressive
点）
liquefaction necrosis of the cornea,
with marked border infiltration of
thinning of the stroma
gray matrix
extensive anterior arial abscess
Work-up
1. History:
Contact lens wear and lens-care regimen 治疗 ?
Swim with lenses?
Trauma or corneal foreign body?
Eye care prior to visit (e.g., antibiotics or topical
steroids)?
Previous corneal disease?
Systemic illness?
Work-up
2. Slit-lamp examination:
Stain with fluorescein to determine if there is epithelial loss
overlying the infiltrate;
document the size, depth, and location of the corneal
infiltrate;
assess the anterior-chamber reaction ;
measure the intraocular pressure (IOP).
Work-up
3. Corneal scrapings for smears and cultures :
infiltrates considered to be infectious and for all ulcers. Small
nonstaining infiltrates are sometimes treated with regular-
strength antibiotics without prior scraping.
Treatment
As mentioned above, ulcers and infiltrates are generally treated as
bacterial initially unless there is a high index of suspicion of another
form of infection (Fungal Keratitis 、 Acanthamoeba 、 Herpes Simplex
Virus).
1. Cycloplegic 散瞳剂
2. Topical antibiotics
3. Consider subconjunctival antibiotics
4. No contact lens wear.
5. Oral pain medication as needed
6. corneal perforation 穿孔 , a corneal transplant or patch 补丁 graft
Follow-up
The most important criteria in evaluating the response to treatment include
the degree of eye pain,
the size of the epithelial defect over the infiltrate,
the size and depth of the infiltrate
the anterior-chamber reaction.
If the ulcer is improving, the antibiotic regimen is gradually tapered.
Otherwise, the antibiotic regimen is adjusted according to the culture and sensitivity
results.
2.3 Fungal keratitis
Symptoms
Pain
photophobia
red eye
tearing
discharge
foreign-body sensation
a history of trauma, particularly with vegetable matter
chronic eye disease
fungal keratitis
Critical Signs
Corneal stromal gray-white opacity (infiltrate) with a feathery
border 、 satellite lesions
The epithelium over the infiltrate may be elevated above the
remainder of the corneal surface
hypopyon
Treatment
If the stains and/or cultures indicate a fungal keratitis institute the
following measures:
● antifungal ： Natamycin 5% (50 mg/ml) drops q 1-2 h while awake,
q 2 h at night.
● Cycloplegic (e.g., scopolamine 0.25% tid).
● Treat glaucoma if present
● No topical steroids.
● corneal transplant
2.4 Herpes simplex virus （ HSV ）
Etiology ：
May have eyelid vesicles or corneal epithelial dendrites.
A history of recurrent eye disease or known ocular herpes is
common.
HSV
Symptoms
Signs
eyelid/skin involvement
unilateral red eye,
Clear vesicles on an
pain,
erythematous （红斑
photophobia （畏光） , 的） base that progress to
tearing,
crusting （结痂） .
Conjunctivitis
decreased vision,
skin (e.g., eyelid) rash （皮
疹） ;
history of previous
episodes.
HSV type
corneal epithelial disease ： corneal stromal
superficial punctate 点状的 keratitis
disease ：
(SPK)
● stellate （星状的） keratitis, Disciform （盘装的） keratitis:
● dendritic （树枝状的） keratitis
Disc-shaped stromal edema
with an intact （完好无损）
● geographic ulcer
epithelium.
Treatment
CORNEAL EPITHELIAL DISEASE
● Antiviral agents
● Cycloplegic （睫状肌麻痹剂） agent if an anterior-chamber reaction is
present.
CORNEAL STROMAL DISEASE （ Disciform keratitis ）
Cycloplegic (e.g., scopolamine 0.25% tid) alone.
Topical steroid (e.g., prednisolone acetate 1% qid).
Antiviral drops for prophylaxis (e.g., trifluorothymidine 1% 3-4
times per day).
Consider a corneal transplant
● Thank you!!!
