Page 41 - NAME OF CONDITION: REFRACTIVE ERRORS

exudate from the lower conjunctival fornix with a calcium alginate swab moistened
with saline. Sheep blood and mannitol agar plates routinely are used. Expect viral
and chlamydial causes in culture-negative conjunctivitis.

 Viral diagnostic tests: Viral cultures are not routinely used to establish a diagnosis. A
rapid, in-office immunodiagnostic test using antigen detection is available for

adenovirus conjunctivitis. Immunodiagnostic tests may be available for other viruses.
Polymerase chain reaction (PCR) may be used to detect viral deoxyribonucleic acid.
RPS adenodetector is a new rapid diagnostic test for identifying adeno viral
conjunctivitis.

 Chlamydial diagnostic tests: Suspected cases of adult and neonatal chlamydial
conjunctivitis can be confirmed by laboratory testing. Immunologically based
diagnostic tests are available, including a direct immunofluorescent antibody test
and enzyme-linked immunosorbent assay.

 Biopsy: Conjunctival biopsy may be helpful in cases of conjunctivitis unresponsive to
therapy. Because such eyes may harbor a neoplasm, directed biopsy may be both
vision-saving and lifesaving. Conjunctival biopsy and immunofluorescent staining
diagnostic tests may be helpful to establish the diagnosis of diseases such as ocular
squamous surface neoplasia (OSSN), ocular mucous membrane pemphigoid (OMMP)
and paraneoplastic syndromes.A biopsy of bulbar conjunctiva should be performed

and a sample should be taken from an uninvolved area adjacent to the limbus in an
eye with active inflammation when OMMP is suspected. In cases of suspected
sebaceous gland carcinoma, a full-thickness lid biopsy is indicated. When considering
a biopsy, a preoperative consultation with the pathologist is advised to ensure
proper handling and staining of specimens.

c) Treatment: The treatment strategies should be revisited to check for adequacy,
appropriateness and affordability. If the culture and other tests show a different
organism, then the treatment regimen should be modified.

Surgical procedure includes:

1. Symblepharon: treated by dividing the symblepharon and to prevent the
reformation of scar tissue during healing period. The formation of scar tissue in
raw area is prevented by single pedicle conjunctival graft, mucous membrane
graft, split skin graft or by amniotic membrane transplantation.

2. Correction of lid abnormality like cicatricial ectropion, cicatricial entropion,
trichiasis etc., by appropriate surgical procedure.
3. Chemical conjunctivitis with severe ocular surface abnormality treated by
ocular surface reconstruction by limbal stem cell graft, conjunctival autograts,

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