Degenerative conditions of Conjunctiva

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Pinguecula

• Degenerative condition
• Triangular yellowish white patch on bulbar conjunctiva near the limbus.
• Apex is away from cornea,
• Affects nasal side first

Pinguecula

Developing calcification

Pingueculitis

• d/t hyaline infiltration and elastotic degeneration of sub mucous tissue.
• Affects older people
• Predisposing factors - strong sunlight,dust,wind etc
• Precursor of Pterygium
• Requires no treatment

Pterygium

Cleared Controversies Cause of blindness in pterygium is loss of visual axis > astigmatism. Non inflammatory connective tissue disorder.

• Non cancerous growth
• c/b wing shaped fold of conjunctiva encroaching upon cornea
• Always situated in the palpebral aperture
• Subconjunctival tissue undergoes elastotic degeneration and proliferates as vascular granulation tissue
• The corneal epithelium,bowman's layer and stroma are destroyed

Etiology & Clinical features

• Predisposing factors - UV B rays,dry heat,high wind,dust
• Usually on nasal side
• Stocker’s line(deposition of Iron)
• Asymptomatic in early cases
• Visual disturbances or Astigmatism
• Diplopia(occasionally)

collagenous

degenerative changes in vascularized subepithelial stroma

Pterygium showing cap

Stocker’s Line

Pseudopterygium secondary to chemical burn

Management

• Asymptomatic cases better left alone
• Surgical excision
• Indications
• Cosmetic reasons
• Progression
• Diplopia
• Simple excision(Bare sclera technique) associated with high recurrence rate(upto 80%)
• Conjunctival autografting is currently most popular approach
• Adjunctive treatment
• Mitomycin c
• Beta radiation
• Amniotic membrane patch grafting