Fornix conjunctiva

Follicles resnlt from focal lymphoid hyperplasia most commonly associated with chlamydial, viral, or toxic exposnre, inclnding preservatives in eyedrops or high levels of chlorine in pool water. Clinically, conjunctival follicles appear as avascular, translucent to whitish gray, amorphons nodnles 0.5 to 1.5 mm in diameter, usually located in the tarsal and fornix conjunctiva. Small external... 

Same as for local corticotherapy, the goal of excision is to reduce the inflammatory reaction due to the products resulting from the alteration of the necrotic conjunctiva and involved in the detersion of the site. Thus, it limits the production of free oxygenated cytotoxic radicals. It also allows the removal of the caustic material that has stored up in these tissues. The excision must be operated as soon as the eyeball has been rinsed and potential foreign bodies ablated. It consists in the ablation of the necrotic tissues of the eyeball surface. The excision of the conjunctiva and of the subconjunctival tissue must be done up to the superior and inferior fornix when required. Only the necrotic and avascular tissues must be removed until the reach of the tissue... 

FIGURE 24.1 Ocular and periocular tissues. EL, eyelid DD, drug droplet COR, cornea AC, anterior chamber PC, posterior chamber AOF, aqueous outflow tract (trabeculum meshwork and Schlemm canal) BCNJ, bulbar conjunctiva PCNJ, palpebral conjunctiva FCNJ, fornical conjunctiva FNX, fornix (conjunctival sac/cul-de-sac) SC, sclera IR, iris CB, ciliary body CHOR, choroid RET, retina ONH, optic nerve head V, vitreous L, lens Z, lens zonulae ORF, orbital fat. 

The palpebral conjunctiva begins at the posterior eyelid margin and extends posteriorly toward the fornix. 

The palpebral conjunctiva is composed of nonkera-tinized stratified epithelium that decreases in thickness as it proceeds from the eyelid margin. Many mucin-secreting goblet cells are located near the fornix. The epithelium overlies the substantia propria, which consists of delicate connective tissue and blood vessels. Most of the immune system cellular components reside in the substantia propria.The stroma contains lymphocytes, lymphoid follicles, neutrophils, plasma cells, and mast cells, all of which proliferate extensively in conjunctival inflammatory disease. This proliferation leads to the formation of papillae and follicles. 

The conjunctiva proceeds onto the globe from the fornix to form the bulbar conjunctiva, which overlies Tenon s capsule and merges with the limbal cornea. Loosely attached to the capsule over the entire globe, the bulbar conjunctiva forms a homogeneous layer of stratified squamous epithelium at the limbus and contains many goblet... 

S. pneumoniae is a common cause of acute bacterial conjunctivitis in children (Figure 25-5). Concurrent upper respiratory tract infections and otitis media, especially in children younger than 4 years, are common. In moderate climates S. pneumoniae is often the cause of acute bacterial conjunctivitis epidemics. This condition commonly presents with diffusely scattered petechial hemorrhages, especially on the superior bulbar conjunctiva, a mucopurulent discharge in the lower fornix, and transient marginal corneal infiltrates. Pseudomembranes may form. 

The conjunctiva is a thin transparent membrane, which lines the inner surface of the eyelids and is reflected onto the globe. The conjunctiva consists of three parts bulbar on the eye surface (sclera), fornix or conjunctival sac and palpebral on the inner side of the eyelids. The bulbar conjunctiva lies upon the sclera and only attaches to the sclera on the limbus. The structure resembles a palisade and is more permeable than the cornea. 

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