Understanding Common Eye Conditions and Treatments

Conjunctival Autoimmune Diseases

Autoimmune diseases associated with skin and mucocicatricial conditions that affect the cornea and conjunctiva:

• Ocular Cicatricial Pemphigoid: Chronic bilateral conjunctivitis that typically appears around 50 years of age, leading to fibrosis, keratinization, and symblepharon. Treatment includes corticosteroids, cyclophosphamide, and dapsone.
• Erythema Multiforme: Includes Stevens-Johnson syndrome (affecting skin and mucosa) and toxic epidermal necrolysis (Lyell's syndrome), often triggered by medication or an infectious process.

Neurotrophic Keratopathy

Etiology: Ablation of the fifth cranial nerve, infection (such as herpes), topical medications (anesthetics), systemic diseases (diabetes mellitus, vitamin A deficiency), iatrogenic causes. Treatment: Protecting and lubricating the cornea through occlusion, tarsorrhaphy, and artificial tears.

Exposure Keratitis

Etiology: Neurogenic (facial paralysis), nocturnal lagophthalmos, proptosis (thyroid mass), eyelid position alterations such as ectropion and entropion.

Herpes Simplex Keratitis

90% unilateral, characterized by dendritic ulcers, geographic ulcers, metaherpetic trophic keratitis, and stromal forms (disciform, stromal scar). The uvea can also be affected, leading to keratouveitis or iridocyclitis.

Band Keratopathy

Causes: Chronic ocular diseases, chronic uveitis (rheumatoid arthritis), interstitial keratitis, chronic corneal edema, phthisis bulbi, aphakic eyes with silicone oil, hypercalcemia, hyperparathyroidism, and hereditary conditions. Treatment: EDTA, cleaning, excimer laser.

Dry Eye

• Aqueous Layer Deficiency:
  • Sjögren's Syndrome: Primary or secondary (associated with rheumatoid arthritis and collagen diseases).
  • Non-Sjögren's: Lacrimal gland issues (blockages, deficit), reflex arc problems, systemic medications.
• Evaporative:
  • Intrinsic: Meibomian gland dysfunction, eyelid opening issues, low blink rate (computer use), certain drugs.
  • Extrinsic: Vitamin A deficiency, preservatives, topical medications, contact lenses, ocular diseases (allergies).

Asthenopia: Difficulty with accommodation. Treatment: Artificial tears, anti-inflammatories (cyclosporine A, corticosteroids), punctal occlusion.

Anterior Uveitis

Etiology: 50% idiopathic. Associated conditions include HLA-B27 positivity (ankylosing spondyloarthritis, Reiter's syndrome, psoriatic arthritis), inflammatory bowel disease, herpes, syphilis, tuberculosis, brucellosis, sarcoidosis, Behçet's disease, trauma, and post-surgery. Juvenile Idiopathic Arthritis: Affects 2-25% of cases, typically bilateral and chronic, often seen in young females under 7 years with oligoarthritis and ANA positivity. Fuchs' Heterochromic Iridocyclitis: Chronic uveitis without systemic disease, characterized by iris discoloration and no synechiae.

Intermediate Uveitis

Typically affects young individuals, presenting as a chronic, idiopathic, bilateral condition. Characterized by cellular infiltration of the vitreous, peripheral retinal deposits (snow banking), periphlebitis, and cystoid macular edema. Posterior segment is not affected. Symptoms include floaters, decreased visual acuity due to vitreous opacity, and macular edema (most frequent).

Posterior Uveitis

Characterized by choroiditis, retinitis (white spots), periphlebitis, vasculitis, vascular occlusion, and varying degrees of vitreous infiltration. Candidiasis abscesses may be present. Symptoms include decreased visual acuity, myodesopsias, and scotomas. 30% of cases are idiopathic. Systemic associations include sarcoidosis, Behçet's disease, and uveomeningeal syndromes. Infectious causes include bacterial (tuberculosis, syphilis), viral (herpes, rubella), fungal, protozoan (toxoplasmosis), and parasitic (toxocariasis). Unknown causes include sympathetic ophthalmia, retinal epitheliopathy, and multifocal choroiditis.

Endophthalmitis

Can be caused by internal or external germs. Symptoms include a sharp and painful loss of vision, corneal edema, anterior chamber with fibrin and hypopyon, and opaque vitreous.