Examination of conjunctiva

Examination of conjunctiva 

1. conjunctival layer of bulb are often examined by simply retracting the upper lid with index and lower lid with thumb of the left .

 2.Lower palpebral conjunctiva and lower fornix It are often examined by just demolition the lower lid and instructing the patient to seem up 

3. Upper palpepral conjunctiva are often examined only after everting the upper eyelid. Eversion of upper lid are often administered by one-hand or two-hand technique. 

One-hand technique. 

In it patient looks down and therefore the examiner grasps the lid margin along side lashes with left index and thumb. 

Then swiftly everts the upper lid by making index a fulcrum. This, however, requires some practice.

 Two-hand technique. 

 it's comparatively easier. Procedure is same as above, except that here the lid is rotated around a hard and fast probe which is held above the extent of tarsal plate with right . 

In slight modification of two-hand technique, index of right are often used rather than probe.

 4. Examination of superior fornix requires double eversion of upper lid using Desmarre’s lid retractor.

  Conjunctival signs 

Normal conjunctiva may be a thin semi-transparent structure. A fine network of vessels is distinctly seen in it. Following signs could also be observed:

 1. Discoloration of conjunctiva could also be brownish inmelanosis and argyrosis (silver nitrate deposits),greyish thanks to surma deposits, pale in anaemia, bluish in cyanosis and bright red thanks to subconjunctival haemorrhage. 

2. Congestion of vessels. 

Congestion could also be superficial (in conjunctivitis) or ciliary/ circumcorneal deep (in iridocyclitis, and keratitis) or mixed (in acute congestive glaucoma). 

3. Conjunctival chemosis (oedema) could also be observed in allergic and infective inflammatory conditions. 

4. Follicles. These are seen as greyish white raised areas (mimicking boiled sago-grains) on fornices and palpebral conjunctiva. Follicles represent areas of aggregation of lymphocytes. Follicles could also be seen in following conditions: _ Trachoma_ Acute follicular conjunctivitis_ Chronic follicular conjunctivities 

5. Papillae are seen as reddish raised areas with flat tops and velvety appearance. These represent areas of vascular and epithelial hyperplasia. Papillae are seen in following conditions:_ Trachoma_ Spring catarrh_ Allergic conjunctivitis_ Giant papillary conjunctivitis 

6. Concretions are seen as yellowish-white hard looking raised areas, varying in size from pinpoint to pin-head. They represent inspissated mucous and dead epithelial cells in glands ofHenle. Common causes of concretions are trachoma, conjunctival degeneration and idiopathic.

 7. Foreign bodies are commonly lodged in fornices and sulcus subtarsalis on palpebral conjunctiva. 

8. Scarring on the conjunctiva could also be within the sort of one line within the area of sulcus subtarsalis (Arlt’s line), irregular, or star-shaped. Common causes of scarring are: _ Trachoma_ Healed membranous or pseudomembranous conjunctivitis_ Healed traumatic wounds_ Surgical scars 

9. Pinguecula may be a degenerative condition of conjunctiva observed in many adult patients. it's seen on the conjunctival layer of bulb , near thelimbus, within the sort of a yellowish triangular nodule resembling a fat drop. 

10. Pterygium may be a degenerative conjunctival fold which encroaches on the cornea within the palpebral area. It must be differentiated from pseudo pterygium 

11.Conjunctival cysts which can be observed are:

_ Retention cyst_ Implantation cyst_ Lymphatic cyst_ Cysticercosis.

 12.Conjunctival tumours.

 a couple of common tumours are dermoids, papillomas and epithelial cell carcinoma.