Download - Eye and ear problems
Ear and eye disorders
• Otitis media• Conjunctivitis
Otitis media Inflammation of the middle ear Common in children types
Acute suppurative otitis media Serous otitis media Chronic suppurative otitis media
Acute suppurative otitis media Etiology
Streptococcus pneumoniae Haemophilus influenzae
Acute suppurative otitis media Predisposing factors
Recurrent upper respiratory tract infection Tonsillitis Cleft palate
Route of infection Via eustachian tube Via external ear Haematogenous route (uncommon)
ASOM: Pathogenesis URTI- usually viral origin Edema of the nasopharyngeal end of ET ET blockage Negative pressure in the middle ear Promotes invasion of pyogenic organism Acute suppurative inflammation Tympanic membrane bulges outward and perforates Release of pus in the external ear Followed by resolution If persistence of infection spread of infection with various complications
ASOM: Complications Acute mastoiditis Facial paralysis Labyrinthitis Extradural abscess Meningitis Brain abscess
Acute suppurative otitis media: morphology Gross:
Edematous and congested middle ear mucosa Haemorrhage Middle ear cavity may be filled with pus
Microscopy: Neutrophilic infiltration in the mucosa Osteoclastic destruction of the mastoid bone Fibrosis
Serous otitis media Insidious onset Accumulation of non-purulent effusion in
the middle ear cleft
Chronic suppurative otitis media Chronic infection of the middle ear cleft Common in developing countries
Types of CSOM Tubotympanic- safe or benign type Atticoantral- unsafe or dangerous type
CSOM- tubotympanic type Involves anteroinferior part of middle ear
cleft Central perforation No risk of serious complications
CSOM- atticoantral type Involves posterosuperior part of middle ear
cleft (attic, antrum, posterior tympanum, mastoid
Attic perforation of tympanic membrane Associated with cholesteatoma Risk of serious complications
CSOM Etiology
Sequelae of acute otitis media Causative organisms
Gram negative bacilli proteus species pseudomaonas aeruginosa
CSOM- tubotympanic type: Morphology
Involvement of anteroinferior part of the middle ear cleft with central perforation of tympanic membrane
Aural polyp (granulation tissue) protuding out thru’ perforation
Loss of ossicular bone
CSOM- atticoantral type: morphology Involvement of posteriosuperior part of middle
ear with attic perforation of tympanic membrane
Osteitis Ossicular necrosis Cholesterol granulomas Cholesteatoma- stratified squamous epithelium
with underlying thin fibrous stroma and central keratin debris- tendency to erode bone and surrounding structures
Clinical features‘TT’typeEar discharge- mucoid or mucopurulent Hearing loss- conductive typeCentral Perforation‘AA’ typeEar discharge- foul smellyHearing loss- mostly conductive typeBleeding Attic perforation
Conjunctivitis Inflammation of conjunctiva
RED EYE
Types of Conjunctivitis Based on duration
Acute subacute Chronic
Conjunctivitis: etiology
Infectious causes Bacterial Viral Fungal Chlamydial parasites
Non-infectious Allergic Irritants Autoimmune Toxic Idiopathic
Bacterial conjunctivitis Causative agents:
Staphylococcus aureus (common) Haemophilius aegyptius H. influenzae
clinically manifest as acute purulent or mucopurulent conjunctivitis
Conjunctiva Hyperemia, edema (chemosis) mucopurulent or purulent discharge
Viral conjunctivitis Common causative agents
Adenoviruses Paramyxoviruses Herpes simplex
Watery clear or serous discharge
Trachoma Form of chronic conjunctivitis (>4wks
duration) caused by chlamydia trochomatis serotypes
A,B,C Endemic in many parts of the world Contagious in the acute stages Common in unhygienic and crowded
surroundings One of the leading cause of blindness
Trachoma
WHO classification (FISTO) Trachomatous Follicles – active disease Trachoma Intense- severe disease requiring
urgent treatment Trachomatous Scarring- old inactive disease Trachomatous Opacities- corneal opacities
with visual loss
Trachoma
Tumors of eye: classificationEye lid tumor- Basal cell carcinoma, Sebaceous carcinoma
Contd.Tumors of conjunctiva Benign: Squamous papilloma
Conjunctival nevi Malignant: Squamous cell carcinoma Melanoma
Tumors of uvea(choroid, iris, ciliary body) Benign-uveal nevi Malignant- melanoma
Tumors of retina Retinoblastoma Retinal lymphoma
Tumours of optic nerve Pilocytic astrocytoma Meningioma
Tumours of orbit: Mesenchymal tumoursBenign Lipoma Haemangioma Schwannoma Neurofibroma Osteoma Chondroma
Malignant tumours Angiosarcoma Chondrosarcoma Malignant nerve
sheath tumours
Tumours of lacrimal gland Pleomorphic adenoma
Retinoblastoma Commonest intraocular malignancy Children Hereditary sporadic
Retinoblastoma: morphology Gross:
exophytic or endophytic retinal growth Creamy whitish in colour with areas of
calcification and necrosis
Retinoblastoma : microscopy
Sheets of small round cells with scant cytoplasm and hyperchromatic nucleiFlexner-Wintersteiner rosettesNecrosis
Well differentiated retinoblastoma
metastasis Brain Bone marrow Prognosis poor
Skin
Macroscopic terms Macule- flat circumscribed, 0.5cm Papule- raised, 0.5cm Vesicle-raised, fluid filled, 0.5cm Pustule- pus filled raised lesion Nodule- raised, >0.5cm
Skin diseases Infections Dermatitis Tumors
Skin infections Bacterial Viral fungal
Bacterial infections Furuncle, boil, carbuncle Impetigo
Furuncle/boil/carbuncle Causative organism- staphyoloccoci Hairy areas- face, axilla Furuncle- Focal suppurative inflammation of
the hair follicle Boil - abscess point Carbuncle- Deep suppuration beneath the
subcutaneous fascia and superficial multiple sinuses
Boil and carbuncle
Impetigo Organisms:
Group A beta hemolytic streptococci Staphylococcus aureus
Common infection in children Site: Face, hands Gross examination- Erythematous macule to small
multiple pustules that ruptures and appears as honey coloured crusted lesion
Microscopic examination- subcorneal pustule
Viral infections Verrucae(warts) Cold sores(herpes simplex)
Verrucae (Wart) Caused by Human papilloma virus (HPV) Direct contact or autoinoculation Any age group Self limiting disease Verrucae vulgaris – common type – hands Flat to raised papules with rough surface Microscopy: Papillomatous hyperplasia
Herpes simplex virus infection Commonly known as Cold sores- mucocutaneous
junction Lip, nose Causative agent: HSV1 & HSV2 Acute primary infection- replication of viruses in the
epidermis-> vesicular eruptions Latent infection-Via sensory nerve spread to the sensory
ganglion and remain in dormant phase ( no replication) Recurrent infection- reactivation of latent viruses-
spread to the skin and mucous membrane from the affected ganglion
Superficial fungal infections Dermatophytes Candidiasis
Superficial dermatophytoses Limited to the stratum corneum Reservoirs- soil, animals
Types of dermatophytoses Tinea capitis- Scalp Tinea corporis-Body Tinea cruris- Inguinal region Tinea pedis- foot web space Tinea versicolor- Upper trunk
Microscopic feature- Hyphae and yeast in the stratum corneum
Tinea corporis (ring worm)
Appears as a circular scaly raised area with clearing in the centre
Cutaneous candidiasis Yeast- candida albicans Nail, nail folds, webs of fingers and toes,
perineum of infants- diaper rash Microscopic features-Yeast like forms and
pseudohyphae
Cutaneous candidiasis
Dermatitis Inflammation of the skin secondary to
immune reaction Acute chronic
Acute eczematous dermatitis Acute immune mediated inflammatory
lesion Red papulovesicular oozing lesion
PathogenesisDelayed type of hypersensitivity reaction Exposure to antigen in the epidermis Sensitization of T lymphocytes and production of T
memory cells On repeated exposure to same antigen, T cells
recruitment at the site of antigenic exposure Release of cytokines Recruitment of inflammatory cells Inflammatory response Occurs within 24 hrs
Chronic dermatitis: Seborrheic dermatitis Chronic inflammatory disease Region with high sebaceous glands- scalp,
forehead Fungal infection- malassezia furfur
Clinical appearnance Macules and papules with greasy base Scaling and crusting Dandruff of the scalp
Psoriasis Common chronic inflammatory disease All ages affected Association with- arthritis, myopathy,
enteropathy T cell mediated inflammation Results in proliferation of keratinocytes,
angiogenesis and inflammation
Clinical features Site of affection- elbows, knees, scalp,
lumbosacral areas, intergluteal cleft Scaly plaque- silver white in colour Nail changes-yellow brown discolouration
with pitting
Lichen planus Chronic inflammatory disorder Self limiting disease Cell mediated immune reaction Malignant transformation in chronic
mucosal lesions
Clinical features Itchy lesions Flat topped papule – coalesce – plaque Dark brown color in dark skinned
individual due to loss of melanin pigment Multiple lesions, symmetrical distribution-
extremities- wrist, elbows
Malignant Tumors of skin Squamous cell carcinoma Basal cell carcinoma Melanoma
Squamous cell carcinoma It is the 2nd most common skin malignancy Sun exposed area Men>females Elderly age group
Predisposing factors Sun exposure Chronic ulcers Old burn scars Ionizing radiation Industrial exposure to carcinogens- tar
UV light – DNA damage- cancer development
Squamous cell carcinoma
Cauliflower like growth orUlcerated lesion
Morphology Tumor arising from epidermal epithelium Invades basement membrane and infiltrates
underlying dermis Nests of malignant tumor cells Stratification Keratin pearls in well differentiated tumors Necrosis- poorly differentiated tumors
Squamous cell carcinoma
Basal cell carcinoma Most common skin tumors Sun exposed areas- face Slowly growing tumors Rarely metastasize Locally invasive- rodent ulcers
morphology Ulcerated lesion with pearly white borderMicroscopic examination- Arises from the basal layer of the epidermis or follicular
epithelium Nest of tumor cells resembling basal layer of the epidermis Peripheral palisading Retraction artifact Cells- small, scant cytoplasm, round to oval hyperchromatic
nuclei Mucoid stroma Inflammatory infiltration in the stroma
Basal cell carcinoma
Basal cell carcinoma
Malignant melanoma