dr.s.veni priya 18.2.16 deg cyst tumors
TRANSCRIPT
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