By Marian S. Macsai MD, Bruno M. Fontes
This identify within the quick prognosis in Ophthalmology sequence offers a wealth of full-color photographs - besides differential diagnoses - in side-by-side web page layouts to help you in picking out a whole diversity of anterior section problems. A templated structure expedites entry to the suggestions you must diagnose the most typical stipulations with regards to the cornea and anterior phase - from basic to complicated - encountered in practice.Coverage of the major good points, diagnostic standards, and healing procedures for corneal infections, anterior uveitis, corneal dystrophies and degenerations - and lots of extra - equips you with the most recent counsel. countless numbers of full-color photographs current stipulations as they found in actual life.Common diagnostic pitfalls talk about what to appear out for while creating a tricky analysis. A templated, color-coded structure and differential analysis bins for every situation assist you make fast, exact scientific decisions.A specialize in the commonest stipulations encountered in perform lets you successfully formulate cures and referrals.SERIES EDITORS: Jay S. Duker, MD, Director, New England Eye middle, Vitreoretinal illnesses and surgical procedure provider; Director, Pediatric Retinal Referral heart, Uveitis & Immunology provider; Professor and Chair of Ophthalmology, Tufts collage university of medication, Boston, MA and Marian S. Macsai, MD, leader, department of Ophthalmology, Evanston Northwestern Healthcare; Professor and Vice-Chair of the dep. of Ophthalmology, Feinberg college of medication, Northwestern college, MI
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59 Same patient as in Fig. 58, showing corneal spread. Definitive diagnosis after excisional biopsy. 57 Squamous Cell Carcinoma Key Facts • Extension of tumor through basement membrane • Related to: • human papillomavirus infection • sun exposure • smoking • Immunosuppressed patients at higher risk of aggressive and bilateral disease • Usually found at limbus in interpalpebral fissure • Pigmentation may be present Clinical Findings • • • • Fleshy gelatinous lesion, usually at limbus Can be sessile or minimally elevated A white plaque (leukoplakia) can occur at the lesion’s surface Engorged feeder vessels Ancillary Testing SECTION 3 • Conjunctiva • Excisional biopsy (can be the definitive treatment) • Exfoliative cytology • Ultrasonography Differential Diagnosis • • • • Conjunctival intraepithelial neoplasia Pinguecula Pterygium Mucoepidermoid carcinoma Treatment • Excisional biopsy • Surgical removal (partial lamellar sclerokeratoconjunctivectomy) and cryotherapy • Topical chemotherapy (mitomycin-C or 5-fluorouracil) Prognosis • Can invade the eye and soft tissues adjacent to the globe • Can metastasize to regional (preauricular and submandibular) lymph nodes (uncommon) Fig.
33 Molluscum Conjunctivitis Key Facts • • • • Dermatotropic DNA poxvirus Humans are the only host More common in children and young adults (especially HIV-infected patients) Spread by close personal contact, can be sexually transmitted Clinical Findings • Chronic follicular conjunctivitis • Pink, umbilicated lesions on lid margin • Superficial punctate keratitis Ancillary Testing • Often a clinical diagnosis • Histopathologic examination can show eosinophilic intracytoplasmic inclusion bodies (Henderson–Patterson bodies) SECTION 3 • Conjunctiva Differential Diagnosis • • • • Herpes simplex Verruca vulgaris (human papillomavirus) Keratoachantoma (early stages) Adenovirus—after all, molluscum typically presents as a monocular follicular conjunctivitis Treatment • Surgical removal (excision or curettage) • Cryotherapy of lesions Prognosis • May resolve spontaneously (months to years) in immunocompetent patients • Occasionally lesions may become secondarily infected • Rarely secondary corneal pannus 34 Fig.
Fig. 29 Giant papillae and copious mucous discharge in the superior tarsal conjunctiva. Vernal Conjunctivitis Fig. 30 Cobblestone papillae. Note size and flattened surface due to permanent contact with the globe. Fig. 31 Gelatinous appearance of limbal follicles and Trantas dots. 41 Vernal Conjunctivitis (Continued) Fig. 32 Limbal form of vernal keratoconjunctivitis. SECTION 3 • Conjunctiva Fig. 33 Trantas dots stained with fluorescein. Fig. 34 Palpebral form, with giant cobblestone papillae (same patient as in Fig.