Conjunctiva

Conjunctivochalasis (CCH) SYMPTOMS Tearing | Discomfort/irritation | Dryness | Often asymptomatic. SIGNS Redundant bulbar conjunctiva (wrinkle appearance) | Disruption of tear meniscus WORK-UP Thorough history. Slit lamp examination TREATMENT Observation | Preservative-free artificial tears | Surgical excision and resection may be indicated in advanced cases | Off-label brimonidine 0.025% (Lumify) has been used with some…

Senile Scleral Plaque SYMPTOMS No symptoms SIGNS Gray area of increased scleral translucency (underlying uvea becomes visible) WORK-UP Thorough history. Slit lamp examination TREATMENT No treatment is required FOLLOW-UP Frequent follow-ups are rarely necessary. ADDITIONAL LAB | TESTS None ETIOLOGY Senescence DIFFERENTIAL DX Scleromalacia perforans | Senile scleromalacia NOTES Can rarely lead to senile scleromalacia…

Conjunctival Nevus SYMPTOMS No symptoms SIGNS Pigmented lesion on the bulbar conjunctiva (rarely on the palpebral conjunctiva) | Usually flat and brown (but can be amelanotic or pink-ish) WORK-UP Thorough history and slit lamp examination. Consider baseline anterior segment photos. TREATMENT Observation with photodocumentation | Suspicious lesions may warrant biopsy FOLLOW-UP Annually to assess for…

Conjunctival Inclusion Cyst SYMPTOMS Irritation/discomfort | Dryness SIGNS Raised conjunctival cavity filled with clear serous fluid WORK-UP Thorough history. Slit lamp examination TREATMENT Observation | Drainage | Surgical excision of the entire cyst. FOLLOW-UP Frequent follow-ups are not required unless surgery is performed ADDITIONAL LAB | TESTS Ultrasound biomicroscopy may be performed if suspicion exists…

Pinguecula SYMPTOMS Mild irritation | Usually asymptomatic SIGNS Yellow-white elevated conjunctival lesion WORK-UP Thorough history. Slit lamp examination TREATMENT Observation | UV-blocking sunglasses | Preservative-free artificial tears for comfort Topical steroids are rarely indicated but if inflamed (pingueculitis) or symptomatic can use: Pred Forte 1% 1 gtt OU qid x 1 week | Lotemax 1…

Pterygium SYMPTOMS Irritation | May affect vision if advanced | Often asymptomatic SIGNS Injection | Wing-like fibrovascular tissue extending from the conjunctiva to the cornea – usually at the 3-9 o’clock position | Iron line (Stocker line) WORK-UP Thorough history. Slit lamp examination TREATMENT Observation | UV-blocking sunglasses | Preservative-free artificial tears for comfort |…

Conjunctival Concretions SYMPTOMS Foreign body sensation | Tearing | Often asymptomatic SIGNS Yellow-white palpebral conjunctival nodules WORK-UP Thorough history. Slit lamp examination TREATMENT Observation | If irritating, can remove with a cotton-tip applicator, small gauge needle, or forceps. FOLLOW-UP Frequent follow-ups are not required ADDITIONAL LAB | TESTS None ETIOLOGY Usually chronic inflammation and aging…

Hordeolum SYMPTOMS No symtoms SIGNS Episcleral blue-gray pigmentation (not conjunctival) | Ipsilateral skin may also be pigmented. WORK-UP Thorough history. Slit lamp examination TREATMENT Observation | Annual eye exams to assess glaucoma and melanoma risk. FOLLOW-UP Frequent follow-ups are not required with no other ocular concerns. ADDITIONAL LAB | TESTS None ETIOLOGY Unknown cause, usually…

Conjunctival Intraepithelial Neoplasia (CIN) SYMPTOMS Discomfort | Irritation SIGNS Gray-white gelatinous lesion(s) | Dilated vessels WORK-UP Thorough history. Slit lamp examination TREATMENT Interferon (IV or topical) | Topical mitomycin C | Topical 5-fluorouracil | Excision with biopsy FOLLOW-UP Every few days during treatment ADDITIONAL LAB | TESTS Consider biopsy ETIOLOGY CIN has a number of…

Phlyctenular Keratoconjunctivitis SYMPTOMS Discomfort | Photophobia SIGNS White nodule on cornea and/or conjunctiva with associated engorged vessels | Conjunctival injection | Possible corneal scarring WORK-UP Thorough history. Slit lamp examination TREATMENT Combination antibiotic/steroid drop: Tobradex 1 gtt qid | Zylet 1 gtt qid FOLLOW-UP Every few days during treatment ADDITIONAL LAB | TESTS Consider tuberculosis…