Conjunctivitis surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]
Overview
Surgical intervention is not recommended for the management of infective and neonatal conjunctivitis. Allergic conjunctivitis is a self-limited disease, and extensive surgery may not be acceptable. However, surgical techniques include superficial keratectomy and penetrating keratoplasty are usually reserved for severe cases of corneal involvement. Despite the availability of efficient tear substitutes, many patients with keratoconjunctivitis sicca (dry eye syndrome) experience severe corneal injuries and a subsequent loss of vision. Surgical techniques include lateral tarsorrhaphy, punctal plugs, lens therapy, amniotic membrane transplantation, and salivary gland duct transposition.[1][2][3][4][5][6][7]
Surgery
Infective Connjunctivitis
Surgical intervention is not recommended for the management of infective conjunctivitis.[1]
Neonatal Conjunctivitis
Surgical intervention is not recommended for the management of neonatal conjunctivitis (ophthalmia neonatorum).[2]
Allergic conjunctivitis
Allergic conjunctivitis is a self-limited disease. Surgical techniques (superficial keratectomy and penetrating keratoplasty) are usually reserved for severe cases with corneal involvement.
Superficial Keratectomy
Superficial keratectomy is not the first-line treatment option for patients with vernal keratoconjunctivitis. Superficial keratectomy is usually reserved for severe cases of corneal shield ulcer.
Penetrating keratoplasty
Penetrating keratoplasty is not the first-line treatment option for patients with atopic keratoconjunctivitis. Penetrating keratoplasty is usually reserved for severe cases of corneal scarring or thinning.
Keratoconjunctivitis Sicca
Despite the availability of efficient tear substitutes, many patients with keratoconjunctivitis sicca (dry eye syndrome) experience severe corneal injuries and a subsequent loss of vision. Surgical techniques include lateral tarsorrhaphy, punctal plugs, lens therapy, amniotic membrane transplantation, and salivary gland duct transposition.[3][4][5][6]
Lateral tarsorrhaphy
If a person has difficulty closing the eyes for any reason, such as Bell's palsy, the eyes may dry out because of tear evaporation. Lateral tarsorrhaphy is a procedure during which the lateral one-third of the eyelids are sewn together to decrease the ability of the eye to open widely and to help the eyes close more easily.[3]
Punctal plugs
A punctal plug is a small device that is inserted into the tear duct. This prevents the drainage of liquid from the eye. Punctal plugs are often used in the treatment of dry eye syndrome. Available types include absorbable plugs, nonabsorbable plugs, thermoplastic plugs, and hydrogel plugs.[4]
Lens therapy
Bandage contact lenses and scleral lenses are available for severe ocular surface disorders in patient with keratoconjunctivitis sicca.
Amniotic membrane transplantation
Amniotic membrane transplantation is used in cases of persistent corneal ulceration and corneal perforation.
Salivary gland duct transposition
Salivary glands have occasionally been transplanted to replace lacrimal glands, but in the long term this led to corneal edema and excessive lacrimation.
Superior Limbic Keratoconjunctivitis
Surgical resection of the involved conjunctiva is not the first-line treatment option for patients with superior limbic keratoconjunctivitis (SLK). Amniotic membrane grafting and lens therapy are usually reserved for patients who are not responsive to noninvasive treatment.[7]
References
- ↑ 1.0 1.1 Wood M (1999). "Conjunctivitis: diagnosis and management". Community Eye Health. 12 (30): 19–20. PMC 1706007. PMID 17491982.
- ↑ 2.0 2.1 Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G (2008). "Neonatal conjunctivitis - a review". Malays Fam Physician. 3 (2): 77–81. PMC 4170304. PMID 25606121.
- ↑ 3.0 3.1 3.2 Rajak S, Rajak J, Selva D (2015). "Performing a tarsorrhaphy". Community Eye Health. 28 (89): 10–1. PMC 4579993. PMID 26435586.
- ↑ 4.0 4.1 4.2 Baxter SA, Laibson PR (2004). "Punctal plugs in the management of dry eyes". Ocul Surf. 2 (4): 255–65. PMID 17216100.
- ↑ 5.0 5.1 Khodadoust A, Quinter AP (2003). "Microsurgical approach to the conjunctival flap". Arch Ophthalmol. 121 (8): 1189–93. doi:10.1001/archopht.121.8.1189. PMID 12912699.
- ↑ 6.0 6.1 Güerrissi JO, Belmonte J (2004). "Surgical treatment of dry eye syndrome: conjunctival graft of the minor salivary gland". J Craniofac Surg. 15 (1): 6–10. PMID 14704553.
- ↑ 7.0 7.1 Nelson JD (1989). "Superior limbic keratoconjunctivitis (SLK)". Eye (Lond). 3 ( Pt 2): 180–9. doi:10.1038/eye.1989.26. PMID 2695351.