dr.s.veni priya 18.2.16 deg cyst tumors

CONJUNCTIVA- DEGENERATIONS ,

CYSTS & TUMOURS DR. S.VENI PRIYA , M.S

PLAN Degenerations : concretion , pingecula ,

pterygium Cysts Tumours – benign & malignant

CONJUNCTIVAL DEGENERATIONS

Pinguela Pterygium Concretions Conjunctivochalasis

DEGENERATIONS

CONCRETIONS

Eldery patients Due to accumulation of

epithelial cells & mucous in Crypts of Henle .

Small,multiple, chalky, yellow- white deposits palpebral conjunctiva

Treatment Removal with needle

Elastotic degeneration &

hyaline infiltration in the submucous tissue.

Yellow white raised lesion at

the limbus in the palpberal aperture. (Pinguis – fat )

Treatment : not needed Inflammed – weak steroid –

fluromethalone

PINGUECULA

DEFINITION: A degenerative condition of the

subconjunctival tissue Proliferates as vascularised granulation tissue

to invade the cornea The word ‘pterygia’ – wing

PTERYGIUM

ETIOLOGY Associated with prolonged UV exposure UV-B limbal stem cell p53 mutation apoptosis /

TGF- growth

• Dryness

• Inflammation

• Exposure to wind, dust or other irritants

PTERYGIUM

PTERYGIUM –

pathogenesis Elastotic degeneration –

fragmentation and breakdown of stromal collagen

Destruction of epithelium & Bowman’s layer by advancing fibrovascular tissue resulting in corneal scarring

PTERYGIUM – symptoms

Fleshy growth in the palpebral

aperture

Visual acuity – reduced

Astigmatism ,↑ glare, pupillary

involvement

Diplopia

Triangular fold of fleshy growth from

conjunctiva seen encroaching on the cornea

PTERYGIUM - SIGNS

PTERYGIUM – parts

Cap Head - cornea Neck – limbus Body

fleshy sheet ,superior and inferior folds

Stocker’s line ?????????????

Types – on growth

PROGRESSIVE PTERYGIUM

Thick & Fleshy highly vascularised Cap present

STATIONARY/ATROPHIC PTERYGIUM

Thin & pale No vascularisation No cap

Nasal Temporal DOUBLE (headed) PTERYGIUM

TYPES – ON THE SITE

PTERYGIUM

TYPES Type I –extends ≤ 2 mm

onto cornea

Type 2 – involve >2 - 4 mm of the cornea

Type 3 – invade ≥ 4 mm of cornea & involve visual axis

CHANGES IN PTERYGIUM Inflammation

Cyst formation

Calcareous degeneration Malignancy – rarely

PTERYGIUM

Surgical excision with conjunctival

autograft / amniotic membraneINDICATION S: Type 2 / 3 pterygium Significant cosmetic blemish

PTERYGIUM – treatment

WHAT IS THE MOST COMMON DISADVANTAGE

OF SURGICAL EXCISION ? recurrence HOW WILL YOU TREAT A RECURRENT

PTERYGIUM? Surgical excision with amniotic membrane

with MMC 0.02%

TREATMENT

symblepharon – adhesion between palpebral

& bulbar conjunctiva secondary to raw areas created by any inflammation ( membranous conjunctivitis ) or chemical injuries

Which resembles a pterygium by appearance

WHAT IS PSEUDOPTERYGIUM ?

PSEUDOPTERYGIUM

TRUE PTERYGIUM PSEUDOPTERYGIUMAge - ≥ 40 yrs Any age Palpebral fissure region Anywhere Organisation into head,body and tail

No such organisation

Firm adhesion at limbus No such adhesion Probe test : cannot be passed under pterygium

probe can be passed

Always progressive initially

Always stationary

No such history History of severe conjunctivitis / chemical burns

PTERYGIUM

What type of astigmatism is expected in

Pterygium? What is Stocker’s line ? What is amniotic membrane ? From where will

you harvest that ? What are the various modalities to prevent the

recurrence of pterygium?

Assignment

RETENTION CYST

Asymptomatic Thin walled lesion

with clear fluid Single / multiple

TREATMENT Simple puncture

CONJUNCTIVAL TUMOURS

BENIGN Congenital – dermoid , dermolipoma Nevus Papilloma Pyogenic granuloma MALIGNANT Ocular surface squamous neoplasia Melanoma Lymphoma Kaposi sarcoma

CLASSIFICATION

Choristomas – normal tissue in abmormal

place DERMOID : Mass of collagenous tissue with

dermal elements covered by stratified squamous epithelium

DERMOLIPOMA : dermoid + fatty tissue Treatment : surgical excision

Dermoid & dermolipoma

Dermoid &

dermolipoma

The most commom melanocytic conjunctival

tumour Risk of malignant transformation is < 1%Signs of potential malignancy Prominent feeder vessels Sudden growth or increase in pigmentation

NEVUS

TUMOURS –BENIGN

PAPILLOMA HPV infection , type 6&11 Pink fibrovascular frond Sessile or pedunculated TREATMENT Large pedunculated

lesion – EXCISION  

PYOGENIC

GRANULOMA Misnomer

Proliferative fibrovascular response to prior tissue insult - inflammation, surgery, or nonsurgical trauma  Elevated red

mass, often with a florid blood supply

MALIGNANT TUMOUR

OCULAR SURFACE SQUAMOUS NEOPLASIA (OSSN)

GELATINOUS LIMBAL SCC

NODULAR SCC FLAT DIFFUSE SCC

TREATMENT – wide surgical excision

MALIGNANT MELANOMA

Limbus Usually pigmented Recurrences & metastasis are

more common TREATMENT : Enucleation

orbital exenteration

VASCULAR TUMOURS

KAPOSI’S SARCOMA Elderly ,

immunocompromised person, HIV

One or more reddish vascular masses that resemble a hemorrhagic conjunctivitis

Chemotherapy / low dose radiotherapy

QUESTIONS

PTERYGIUM CAUSE OF

DEFECTIVE VISION IN PTERYGIUM

HOW TO PREVENT RECURRENCES

Types of pterygium Draw the pterygium

& mark the parts