Trauma conjunctival

Figure 1-1 Self-induced injury. Fluorescein staining of the inferior bulbar conjunctiva shows a typical epithelial defect caused by contact with an ointment tube tip. (From Solomon A. Inadvertent conjunctival trauma related to contact with drug container tips. Ophthalmology 2003 110 798.)...

Solomon A, et al. Inadvertent conjunctival trauma related to contact with drug container tips a masquerade syndrome. Ophthalmology 2003 110 796-800. 

The differential diagnosis of OCP varies depending on the stage of the disease. It includes conditions that produce cicatricial changes of the ocular surface, such as chemical trauma, radiation injury, and other mucous membrane disorders. Conjunctival biopsy can aid in the diagnosis. Immunofluorescence study of the tissue demonstrates deposition of immunoreactants at the epithelial basement membrane zone in OCP. 

Direct trauma is the most frequent cause of conjunctival abrasions, contusions, or lacerations. The nature of the contact usually determines what type of woimd the patient suffers. For example, a thrown object may cause only a contusion, whereas a sharp pencil point can lacerate the conjunctiva. 

With each blink the antigen-coated contact lens mechanically traumatizes the tarsal conjunctiva. This process causes the release of mediators, such as neutrophil chemotactic factor and eosinophil chemotactic factor, which attract inflammatory cells (e.g., neutrophils, eosinophils, mast cells, and basophils). The immunologic sequence of events results in an increase in tear immunoglobulins IgE and IgG and C3 anaphylatoxin. The tear immunoglobulins and C3 anaphylatoxin then interact with the inflammatory cells produced from the mechanical trauma. This interaction causes the release of vasoactive amines, resulting in subsequent clinical manifestations. Papillae formation is related to structural changes in the conjunctival epithelium and stroma associated with increased eosinophils and inflammatory cells. 

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