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Miscellaneous Conjunctival Diseases

 

1. SYMBLEPHARON

Definition:-

It is the adhesions between the palpebral conjunctiva in one side and bulbar conjunctiva or the cornea on the other side.

Types and etiology:-

1. Posterior symblepharon:

Obliteration of the fornix (shallow fornix). it occurs in cases of healed trachoma.

2. Anterior symblepharon:

Adhesions occur between the palpebral conjunctiva near the lid margin and bulbar conjunctiva or cornea. It occurs in cases of:

- Chemical burns.

- After recurrent pterygium excision.

- Diphtheritic conjunctivitis.

3. Total symblepharon:

Complete adhesions between the lid and globe. It has the same causes of anterior symblepharon.

Clinical picture:-

Symptoms:

1. Visual symptoms:-

- Visual impairment due to involvement of the cornea by scar.

- Binocular diplopia due to limitation of eye movement.

2. Cosmetic disfigurement.

Signs:

Adhesions are seen to be either posterior, anterior or total.

Treatment:-

A. Prophylactic treatment:

1. Prompt treatment of the cause.

2. prevent apposition of raw conjunctival surfaces during healing:

- Corticosteroid ointment is used several times a day. The greasy base of the ointment isolates the row surfaces from each other while the steroid material decreases the fibrous tissue formation.

- Sweeping a glass rod in the conjunctival sac to cut the newly formed fibrin adhesions.

- Using an artificial large plastic contact shell.

B. Curative treatment:

- The adhesions are cut.

- Then the row surfaces are covered by:

     * Graft from the other conjunctiva if the defect is small.

     * Graft from the mucosa of the mouth if the defect is large.

 

2. PANNUS

1. Trachoma (it is the commonest).

2. Phlyctenular pannus.

3. Degenerative pannus in blind irritated eyes as absolute ACG.

4. Mechanical pannus due to rubbing lashes.

5. Leprosy.

3. Conjunctival pigmentation

Normally there is melanin pigmentation in the conjunctiva.

Abnormal conjunctiva pigmentation occurs in cases of:

I. Exogenous pigmentation:-

1. Argyrosis: greyish pigmentation especially in the lower fornix due to repeated painting by silver nitrate.

2. Siderosis of conjunctiva appears as a rusty brown discoloration due to iron subconjunctival foreign body. .

II. Endogenous pigmentation:-

1. Jaundice.

2. Melanin pigmentation of cases of Addison's disease and malignant melanoma of the conjunctiva.