Diffuse reflectance spectra of the palpebral conjunctiva
and its utility as a noninvasive indicator of total hemoglobin.
The eyelid is composed of multiple layers; these are, in order from outermost to innermost, epidermis, dermis, subcutaneous tissue including a thin layer of adipose tissue, orbicularis oculi muscle, orbital septum, levator muscle, tarsal plate, Muller muscle, and palpebral conjunctiva
Giant papillary conjunctivitis (GPC) is most likely to arise due to a combination of inflammatory events and mechanical trauma to the palpebral conjunctiva.
3-1mm in diameter) or giant papillae (>1mm), swelling and hyperaemia on the superior palpebral conjunctiva and may be accompanied by mucous discharge and increased lens movement when in situ.
VKC is frequently bilateral (98% of cases) and signs include giant papillae (>1mm diameter) on the palpebral conjunctiva (cobblestone appearance) or at the limbus, Horner-Tranta's dots at the superior limbus (gelatinous accumulation of degenerate eosinophils and desquamated epithelial cells; white in appearance), diffuse conjunctival hyperaemia and oedema, and thick, white/yellow, stringy mucous discharge.
8,54) Less common signs include pin-point (petechial) sub-conjunctival haemorrhages, and, in severe cases, pseudomembrane formation, representing coagulated exudate that is loosely adhered to the palpebral conjunctiva.
59,60) Pseudomembranes can be removed by debriding them from the palpebral conjunctiva using a sterile, wet cotton bud or forceps, after instillation of topical anaesthetic.
Irritation, pain, stinging, photophobia, blurred vision Angle closure Sudden onset, usually unilateral, eyeball glaucoma tenderness, pain, headache, reduced visual acuity Symptoms Anterior Sudden onset, usually unilateral (sometimes uveitis bilateral in chronic disease), eyeball tenderness, pain, headache, reduced visual acuity, photophobia Keratitis Many forms of keratitis (including bacterial and (corneal viral causes), but usually unilateral, causing inflamma- pain, photophobia and reduced visual acuity tion) Condition Signs Allergic Diffuse conjunctival hyperaemia, chemosis, conjunc- papillae on palpebral conjunctiva, mucous tivitis discharge, eyelid swelling (puffy eyes) Irritant Conjunctival hyperamia, eyelid swelling, diffuse conjunc- punctate corneal and conjunctival staining.
0mm in diameter) and hyperaemia on the superior palpebral conjunctiva (Figure 3), excessive contact lens movement and intolerance, increased mucous production and symptoms such as burning, itching and irritation.
50,55,60,61) Refitting patients from HEMA to a RGP lens can reduce the recurrence of CLGPC by 80%; (50) the latter has been attributed to the smaller diameter of RGP lenses, which reduces the area in contact with the palpebral conjunctiva for mechanical irritation and exposure to surface deposits.
A further extension of such reactions may be the development of neovascularization or deeper infiltrates (in the palpebral conjunctiva, corneal epithelium or stroma) both of which are the clear signs of an extended recruitment of inflammatory cells in response to persistent irritation.
Eyelid movement across lifted edges of an abrasion may exacerbate this and/or the non-wetting surface of the lesion may adhere to the overlying palpebral conjunctiva (which is likely to be inflamed due to the response to the abrasion).