Chapter 618 Disorders of the Conjunctiva
Conjunctivitis
The conjunctiva reacts to a wide range of bacterial and viral agents, allergens, irritants, toxins, and systemic diseases. Conjunctivitis is common in childhood and may be infectious or noninfectious. The differential diagnosis of a red-appearing eye includes conjunctival as well as other ocular sites (Table 618-1).
Vernal Conjunctivitis
This usually begins in the prepubertal years and may recur for many years. Atopy appears to have a role in its origin, but the pathogenesis is uncertain. Extreme itching and tearing are the usual complaints. Large, flattened, cobblestone-like papillary lesions of the palpebral conjunctivae are characteristic (Fig. 618-1). A stringy exudate and a milky conjunctival pseudomembrane are frequently present. Small elevated lesions of the bulbar conjunctiva adjacent to the limbus (limbal form) may be found. Smear of the conjunctival exudate reveals many eosinophils. Topical corticosteroid therapy and cold compresses afford some relief. Topical mast cell stabilizers or prostaglandin inhibitors are useful when long-term control is needed. The long-term use of corticosteroids should be avoided.
Parinaud Oculoglandular Syndrome
This represents a form of cat-scratch disease and is caused by Bartonella henselae, which is transmitted from cat to cat by fleas (Chapter 201). Kittens are more likely than adult cats to be infected. Humans can become infected when they are scratched by a cat. In addition, bacteria may pass from a cat’s saliva to its fur during grooming. The bacteria can then be deposited on the conjunctiva after rubbing one’s eyes after handling the cat. Lymphadenopathy and conjunctivitis are hallmarks of the disease. Conjunctival granulomas may develop (Fig. 618-2). The course is generally self-limited, but antibiotics may be used in some cases.
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