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Ocular Immunological Rxns (Discharge (Mucoid inc goblet cell secretion …
Ocular Immunological Rxns
inflammation
Chronic
Infiltration of:
macrophages
lymphocytes
fibroblasts
plasma cells
fine blood vessels
Results: scarring, fibrosis, alt. in tissue structure
Acute
Onset: minutes=>week
Vessels: vasodilation, inc. blood flow, inc. vessel permeability & exudation
Movement of leukocytes and neutrophils to affected area
Results:
1) complete resolution
2) healing w/ scar formation
3) =>chronic inflammation
Discharge
Mucoid
inc goblet cell secretion
opaque
bacterial, viral conjunctivitis
Purulent/Muco-purulent
addition of PMNs
inc inflam. response
thick, tan, yellow
Watery/Serous
composition: tears, serous exudate
clear
Viral, allergic, irritative conjunctivitis
Sanguinous
contains erythrocytes
red in color
seen w/ bv injury
Fibrinous
contains fibrin
Signs & Symptoms of inflammation
Rubor: redness of hypermia (vasodilation)
Dolor: pain from swelling of sensory fibers
Calor: heat from inc. blood flow
Tumor: swelling from inflam. edema
Conj. Inflam. Resp
(Palpebral)
Papillae
What:
small "nipple like" palpebral conj. elevations
dilated arteriole in center surr. by edema
vascular tiss. invaded by inflam PMNs
Papillary Hypertrophy
inc. redness (hyperemia) of palp. conj.
acute inflam
inc in size
Giant Papillary Conjunctivitis (GPC)
"cobblestone" elevations (anchoring septa lost)
Chronic inflam
allergic, bact, irritative conjunctivits
Follicles
What:
oval palp conj. elevations "rice like"
aggregations of lymphocytes & lymphoid tissue
single bv along base or over top
viral, chlamydia, toxic conjunctivitis
Conj. inflam. Resp
(Bulbar)
Chemosis
bulbar conj. edema
Hypermia
inc #, caliber, tortuosity of BVs
Acute
mild to moderate (1+, 2+)
Bulbar conj
hyperemia
inc vasc permeability
mild chemosis
mild obstruct. of underlying vasc.
Palpebral conj
hyperemia or papillary hypertrophy
small follicles @ med & lat superior tarsus
serous or mucoid discharge
moderate to severe (3+, 4+)
Bulbar conj
marked hyperemia
marked chemosis
marked underlying vasc. obstruct
subconj. hemorrhage
Palp conj
marked papillary response (papillary hypertrophy)
conj. memb or pseudomemb.
Chronic
mild to severe (1+, 4+)
Bulbar conj
conj. chalasis
symblepharon
dry eyes
keratinization
Palp conj
concretions
retention cysts
cobblestone papillae
fibrosis, scarring
adenochrome: oxidized epinephrine
Eyelids
neovasc., telangiectasia of vessels on lid margins
madarosis
tylosis
trichiasis
entropion
ectropion
Cornea inflam resp
corneal infiltrates
stromal WBCs
ep. edema
stromal edema
corneal ulceration
neovascularization
scarring=>opacification
Lymphatic inflam resp
Lymphadenopathy
swelling/tenderness of pre-auricular & sub-mandibular lymph nodes
Viral conjunctivitis
Lymphangiectasia
linear or round
clear fluid filled bulbar conj. lymphatic
Other
Dermatitis
eczema, erythema, edema, crusting, scaling, lichenification (thickening of skin)
Blepharitis
Seborrheic: greasy, assoc. w/ sebum of sebac. glands
Staph: "cornflake-like" collarette-like, fibrin deposits
Chalazion: chronic granulomatous inflammation of meibomian gland
thickened, plugged meibomian gland
Acne Rosacea
hypertropy of sebac. glands, dilation of capillaries, erythema, papules, pustules
Rhinophyma: hypertrophy of nose
vasomotor instability, abnormal skin protein=>chronic inflam, assoc. w/ conj & corneal inflam.
Hypersensitivity Rxns
Type II
Abs dependent cytotoxic
rxn to sol. IgG, IgM Ab w/ memb. bound Ag
IgG activates complement
ex: graves disease, moorens ulcer, graft rejection
Type III
accumulation of immune complexes (Abs & Ags)=>accumulate on vessel walls=>vasculitis
ex: stevens-johnson syndrome, sjogrens syndrome
Type I
IgE bind to mast cell/basophil receptors=>degranulation=>release histamine, proteases, eosinophils, neutrophils
prior exposure to allergan req.
ex: hayfever, vernal conjunctivitis, GPC
Type IV
Delayed Abs independent, cell mediated resp of T-cells against Ag
occurs 24-72hrs after allergan exposure
T-cells recog. Ag directly=>release lymphokines
ex: contact dematitis, vernal, GPC