INFLAMMATION OF THE EYE

BAGIAN PATOLOGI ANATOMI FAKULTAS KEDOKTERAN UNIVERSITAS ISLAM SUMATERA UTARA 2010

Clinical Manifestation of Eye Disease

Pain : - many different types
- conjunctival / corneal : associated with itching, burning + photophobia - >> : glaucoma

Visual Disturbances
- decreased visual aquity (amblyopia) - spots / halos : cataract / glaucoma - diplopia : eye muscle disfunction

Discharge
- increasing tearing ( eg. : allergic) - microscopic : inflam.cells / viral or chlamydial inclusions

Change in Appearance :
strabismus (muscle imbalance), hemorrhage, congestion, jaundice, swelling, displacement (eg.proptosis), tumors

The Eye Lid

Blepharitis : low grade inflammation

Hordeolum
- acute suppurative inflam. of hair folicle : + sebaceous glands (Zeis) + + apocrine glands ( Moll) - caused by Staph. aureus

Chalazion
- involving meibomian glands

- cause by duct obstruction : - leading to retention of secretions

infection

chronic inflam. ( macrophages, lymphocyte, plasma cells)

- produces mass : mistaken for a neoplasm

The Conjunctiva & Cornea

Keratoconjunctivitis
-inflam. of conjunctiva : conj.tis -Inflam.of the cornea : keratitis -frequently both involve : keratoconj.tis

Acute Bacterial Conj.tis

- pain, hyperemia (vascular injection) :red eye, - discharge (neutrophils) - common : Neisseria, pneumococcus, Haemophilus aegyptus - severe cases : ulceration, involves cornea : visual impairment

Opthalmia Neonatorum : infection of the fetus w/ N. gonorrhoeae

during delivery through the birth canal

Red eye ; OS>OD

Crusting on the lashes

Conjunctival injection with a follicular conjunctivitis.

Ciliary flush along the corneal limbus.

Follicles on the palpebral conjunctivae

 Viral Conj.tis : adenoviruses / herpes simplex virus

Corneal scar by recurent herpes simplex keratitis

Inclusion Conj.tis - swimming pool conj.tis - acute inflam. With pain, red eye, discharge - histologically : accum.of lymphocyte in conj. - caused by Chlamydiae : cytoplasmic inclusions in infected cells in the exudate - transmited : contaminated hands, shared towels, fetus by infected birth canal - self-limited : after few days

Trachoma
- serious Chlamydial infection - long term destruction of the cornea - non early treated : blindness - acute inflam. progress to chronic epithelial hyperplasia + lymphocytic infiltration + pannus formation inflammed mass of granulation tissue replaced superficial layers of the cornea blindness Acanthamoeba Keratoconj.tis - caused by amoeba : Acanthamoeba, contaminated lens cleaning fluids

Allergic Conj.tis
- vernal / spring conj.tis - typically seasonal - + hay fever - hstpl : goblet cell hyperplasia, lymphocyte and eosinophils infiltration

 Phlyctenular

Conj.tis

- delayed hypersensitivity response to Ag bacteria ( M.tuberculosis, S.aureus) - elevated, hard, red triangular plaque at the limbus ulcerate

heals ( 2 weeks)

The Eye Ball

Bacterial

Infection

- pyogenic bacteria (staph) :entry the eye ball by : > penetrating injuries > orbital cellulitis > blood stream - endophtalmitis or panophtalmitis
Toxoplasma

Chorioretinitis

- Toxoplasma gondii choroid and retina - Congenital or Acquired - hstpl : focal coagulative necrosis of retina / choroid + granulamatous inflam. + fibrosis Toxoplasma : crescent-shapes trophozoites / larger pseudocyst

 Ocular

Larva Migrans

- larva of Toxocara Canis ( dogs) to interior eye by uveal or retinal blood vesels - granulomatous endophtalmitis with eosinophils around the larva

Noninfectious - Sarcoidosis :

Inflammatory conditions
- acute iridocyclitis / granulomatous disease

- Rheumatoid Arthritis :

- scleritis / uveitis - foci of necrotic of collagen surounded by palisading histiocytes - Ulceratives colitis and Crohns Disease : non spesific chronic uveitis
- Ankylosiing Spondylitis : anterior uveitis - Sympathetic Ophthalmia - Bahcets syndrome