D/D OF CONJUNCTIVAL SIGNS:
Conjunctival membrane:
True conjunctival membrane
· infective:
Bacterial: streptococci, pneumococci, and corynebacterium diphtheria, ligneous conjunctivitis,
viral: adenovirus √√√√
· chemical burns
conjunctival pseudomembrane
All of the causes of true membranes +
Ocular Cicatricial pemphegoid
Steven Johnson Syndrome
Superior limbic Keratoconjunctivits
gonnococal and chlamydial infection in newborns
Symblepharon
[This is the adhesion between the conjunctival surfaces or between the conjunctival surface and the cornea. This sign may be easily missed if the lids especially the lower lids are not everted, there may be associated shortening of the fornix. In clinical examination, the most common cases are ocular cicatricial pemphigoid (usually bilateral) or chemical injury (usually unilateral)]
· Congenital
isolated or associated with systemic condition such as Goldenhar’s syndrome
· Acquired
traumatic including chemical injury
post-surgical (Commonly seen with pterygium operation. The condition can also occur following conjunctival incision for retinal detachment or squint surgery)
inflammatory conditions (this include ocular cicatricial pemphigoid and Steven-Johnson's syndrome)
Cicatricial conjunctivitis: (D/D of inferior symblepharon)
· Autoimmine diseases
Steven Johnson
OCP
AKC (atopic keratoconjitis)
Sjogren’
SLE
Sarcoidosis
PSS
· Trauma:
Chemocal burn
Conj. surgery eg pteryguim, conj incision for vitroretinal procedures
· Tumours:
Squamous cell carcinoma
· Drugs:
Topical: antiglaucomas
Systemic: proctolol/ penicillamine
· Infections-membraneous conjunctivits:
B strept
Adenoviral
Diphth.
Conjunctival telangiectasia:
· Hereditary haemorrhagic telangiectasia
· Fabry's disease
· Ataxia telangiectasia
· Sturge-Weber's syndrome
· Diabetes mellitus
· Sickle cell anaemia
· Polycythemia rubra vera
· Multiple myeloma
Pigmented lesion of the conjunctiva
(This is rarely the only physical sign in the examination except perhaps adrenochrome. This is because the adrenochrome is found mainly in the fornix and tarsal conjunctiva and unless you perform a methodical examination by everting the lids during slit-lamp examination the sign is easily missed).
Pigmented lesions are best classified into melanocytic and non-melanocytic lesions
· Melanocytic lesions:
congenital pigmentation
benign epithelial melanosis
melanosis oculi
Naevus of Ota
Acquired melanosis
primary acquired malenosis
secondary pigmentation
Addison's disease,
radiation
chronic irritation
XP
pigmented naevi - seen mainly in the bulbar conjunctiva with cystic appearance
malignant melanoma
primary: arising from the naevi, primary acquired melanosis and rarely congenital melanosis
secondary: extension from the uveal tumour or metastasis from the skin
· Non-melanocytic lesions
Pigment deposits (such as adrenochrome, argyrosis)
Foreign body (such as iron)
Staphyloma (due to thinned sclera )
Alkaptouria (pigmentation at the insertion of horizontal recti)
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