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MalaCards based summary: Phlyctenulosis, also known as phlyctenular keratoconjunctivitis, is related to breast cancer and parathyroid carcinoma.
Corneal abrasion is probably the most common eye injury and perhaps one of the most neglected.
A traumatic corneal abrasion is the classic corneal abrasion in which mechanical trauma to the eye results in a defect in the epithelial surface. Foreign bodya€“related abrasions are defects in the corneal epithelium that are left behind after the removal of or spontaneous dislodgement of a corneal foreign body.
Contact lensa€“related abrasions are defects in the corneal epithelium that are left behind after the removal of an overworn, improperly fitting, or improperly cleaned contact lens. Spontaneous defects in the corneal epithelium may occur with no immediate antecedent injury or foreign body.
The diagnosis of corneal abrasion can be confirmed with slitlamp examination and fluorescein instillation (see Workup). The cornea is a transparent cover over the anterior part of the eye that serves several purposes: protection, refraction, and filtration of some ultraviolet light. A corneal abrasion is a defect in the surface of the cornea that is limited to the most superficial layer, the epithelium, and does not penetrate the Bowman membrane. Under normal circumstances, the limbal epithelium acts as a barrier and exerts an inhibitory growth pressure that prevents the migration of conjunctival epithelial cells onto the cornea. Stem cells from the limbus also respond by proliferating to give rise to daughter cells called transient amplifying cells. The concept that the limbal cells form a barrier to conjunctival cells was supported further by the observation that rabbit eyes treated for 120 seconds with N -heptanal, which removed the corneal and conjunctival epithelium but left the limbal basal cells intact, healed with the corneal epithelium and had unvascularized corneas. Demonstration of the centripetal migration of limbal cells (marked by India ink) provided more direct evidence of this concept. Why the conjunctival epithelium should proliferate in response to a central corneal wound is unknown. Alternatively, conjunctival cells may migrate into the limbus or cornea to help replenish the wound area. Although transient attachments are regularly formed and released during the cell migration process, formation of normal adhesions takes 6 weeks, according to Dua et al.[3] Tiny buds of corneal epithelium are present along the contact line between the normal corneal epithelium and the migrating conjunctival epithelium.
The magnitude and extent of both the conjunctival and corneal regenerative responses to a corneal abrasion correlate with the size of the wound.
Insults caused by chemical injuries, Stevens-Johnson syndrome, contact lensa€“induced keratopathy, and aniridia result in limbal damage. A long-standing clinical observation is that corneal abrasions and bacterial corneal infections do not occur in patients with an intact, healthy epithelium. The common feature among the 3 groups is a defect in the corneal epithelium to which the bacteria must adhere to start the infection. Corneal swelling induced by overnight wearing of contact lenses is the most important factor. In persons with trachoma, the constant corneal abrasion by lashes and inadequate tears can produce corneal erosions, ulceration, and scarring. Contact lensa€“induced epithelial defects or direct trauma during lens insertion or removal can cause corneal abrasions. Abrasions occur more frequently with rigid lenses than with other lenses, possibly because of their small diameter and the sharp corneal defects they cause. A foreign body may become trapped under a contact lens and produce linear scratch marks on the cornea. A soft lens offers no protection against blunt trauma to the eye, but it does not pose any additional jeopardy in terms of eye trauma. Adverse corneal events, such as corneal abrasions, have been reported with techniques of overnight corneal reshaping with orthokeratology.
In places where soccer is played frequently, impact with the soccer ball causes approximately one third of all sports-related eye injuries. Although significant eye injuries are not a major risk in equestrian events other than polo, cross-country riders frequently have corneal abrasions from hitting tree branches overhanging the trail. Although cross-country skiing causes fewer musculoskeletal injuries than alpine skiing, cross-country skiers are more likely than alpine skiers to have eye injuries, especially corneal abrasions from contact with tree twigs.[10] Both cross-country and downhill skiers can have solar keratopathy (snow blindness) and injuries due to accidents with ski poles. In patients undergoing eyelid surgery, corneal abrasion can result from sutures inadvertently placed through the tarsus or conjunctival surface.
General anesthesia is more likely to cause adverse systemic effects than local or ocular complications. The SchiA?tz tonometer must be used in the supine position or in the sitting position with the head back far enough to be horizontal. Corneal abrasions are the most common eye injuries and are especially prevalent among people who wear contact lenses. Workplace eye injuries cause significant yet avoidable (with protective eyewear) morbidity and lost productivity. A study of eye injuries in a major US automotive corporation found an annual incidence of 15 eye injuries per 1000 employees. In another report, most patients with corneal foreign bodies did not take more than 1 day off work, and up to 30% sought treatment outside of working hours to avoid lost time from work.
The incidence of nonpenetrating injuries to the eye, which includes corneal abrasions, is 1.57% per year. At a general hospital emergency department in the United Kingdom, 6% of all new cases were eye cases.
The incidence of corneal abrasion is higher among people of working age because younger people are more active than older people; however, people of all ages can have a corneal abrasion. The prognosis is usually excellent, with full recovery of vision if treatment is prompt; however, untreated corneal abrasions can lead to blinding corneal ulcers. Some deep abrasions (eg, those involving the corneal stromal layer) in the central visual axis (ie, the central area of the cornea directly over the pupil) heal but leave a scar. Recurrent epithelial erosion sometimes occurs days to weeks after a healing of an abrasion caused by shearing injury (eg, from a fingernail or mascara brush). Significant morbidity is uncommon and mostly observed with infectious complications or allergies to medications used for treatment. Corneal abrasions associated with contact lenses can progress to pseudomonal or amebic keratitis and lead to further ocular damage (including perforation or corneal scarring) if not treated promptly.[16] Abrasions involving exposure to vegetable matter are at a high risk for becoming fungal ulcers.
Minor injuries may place substantial economic burdens on otherwise healthy people because of time lost from work or school.


A large study showed that 32% of automobile workers with eye injuries were unable to resume their normal duties for at least one day. This corneal abrasion appears as a yellow-green area when stained with fluorescein and viewed with a blue light. Medscape's clinical reference is the most authoritative and accessible point-of-care medical reference for physicians and healthcare professionals, available online and via all major mobile devices. The clinical information represents the expertise and practical knowledge of top physicians and pharmacists from leading academic medical centers in the United States and worldwide. More than 6000 evidence-based and physician-reviewed disease and condition articles are organized to rapidly and comprehensively answer clinical questions and to provide in-depth information in support of diagnosis, treatment, and other clinical decision-making. More than 1000 clinical procedure articles provide clear, step-by-step instructions and include instructional videos and images to allow clinicians to master the newest techniques or to improve their skills in procedures they have performed previously.
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Access health plan drug formulary information when looking up a particular drug, and save time and effort for you and your patient. Medscape Reference features 129 medical calculators covering formulas, scales, and classifications. Hundreds of image-rich slideshow presentations visually engage and challenge readers while expanding their knowledge of both common and uncommon diseases, case presentations, and current controversies in medicine. Click on citations within drug and disease topics in our clinical reference to review the clinical evidence on MEDLINE.
Medscape is the leading online destination for healthcare professionals seeking clinical information. All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. An important gene associated with Phlyctenulosis is AOC1 (Amine Oxidase, Copper Containing 1).
Dans la grande majorite des cas l’ectropion est du a un relachement de la sangle palpebrale. Neither the service provider nor the domain owner maintain any relationship with the advertisers. It occurs because of a disruption in the integrity of the corneal epithelium or because the corneal surface scraped away or denuded as a result of physical external forces.
Examples include corneal or epithelial disease (eg, dry eye), superficial corneal injury or ocular injuries (eg, those due to foreign bodies), and contact lens wear (eg, daily disposable soft lenses, extended-wear soft lenses, gas-permeable lenses, hard polymethylmethacrylate lenses).
Foreign body abrasions are typically caused by pieces of rust, wood, glass, plastic, fiberglass, or vegetable material that have become embedded in the cornea.
In these cases, the mechanical insult is not from external trauma but rather from a foreign body that is associated with specific pathogens. Eyes that have suffered a previous traumatic abrasion or eyes that have an underlying defect in the corneal epithelium are prone to this problem. Prophylactic topical antibiotics are given in patients with abrasions from contact lenses, who are at increased risk for infected corneal ulcers, but many emergency physicians have stopped using these agents for minor injuries. It has no blood vessels and receives nutrients through tears as well as from the aqueous humor. Like the rest of the surface of the body, the conjunctiva and the cornea are in a constant state of turnover. However, movement from the limbus to the center of the cornea is slow and may require months.
During corneal healing of a lesion, corneal epithelial cells become flattened, they spread, and they move across the defect until they cover it completely. These cells migrate to heal the corneal defect and proliferate to replenish the wounded area. These cells migrate in masses as a continuous, coherent sheet, with most cells retaining their positions relative to each other, much like the movement of a herd of cattle. Cell migration can be inhibited by blocking polymerization of actin, indicating that actin filaments actively participate in the mechanism of cell motion.
One possibility is that the proliferation replenishes the number of goblet cells, which decreases by up to 50% after corneal wounding. No firm data suggest that conjunctival epithelium migrates onto the corneal surface in the presence of intact limbal epithelium. Epithelial cells migrate rapidly and develop strong, permanent adhesions within 1 week when the basement membrane is regularly formed and released during the cell migration process.
These buds arise from the corneal epithelium, and normal corneal epithelium appears to replace the conjunctival epithelium by gradually pushing it toward the limbus.
Large erosions were reported to induce a pronounced response in the rate of epithelial cell migration and mitosis at the limbus.
These insults cause delayed healing of the cornea, recurrent epithelial erosions, corneal vascularizations, and conjunctival epithelial ingrowth.
Mechanisms underlying the development of epithelial defects in the first 2 groups are self-evident. Overnight wearing of soft lenses, which do not provide sufficient oxygen transmissibility to prevent hypoxia, causes superficial desquamation of epithelium and increases the propensity for abrasions.
Corneal abrasions due to soft lenses are observed most frequently with tight or extended-wear lenses.
Lang concluded that corneal compromise and poor compliance can cause adverse events with corneal reshaping.[6] The need for ongoing patient education is important in both children and adults who wear contact lenses. Most basketball-related eye injuries are corneal abrasions caused by an opponent's finger or elbow striking the player's eye.
Wearing spectacles with polycarbonate lenses provides adequate protection against this risk. Ocular problems that do occur are usually not serious and include corneal abrasion, chemical keratitis, hemorrhagic retinopathy, and retinal ischemia (rare). Simple precautions, such as instilling a bland ointment or taping the lids of the nonoperative eye closed, may prevent surface trauma produced by the surgical drape, anesthetic mask, or exposure.
In addition, if the disinfectant solution (eg, alcohol) is not removed from the plunger, it can cause a local chemical keratitis where it touches the cornea.


An initial blink or avoidance reaction may occur as the patient sees the tonometer descending toward the eye.
Although corneal abrasions account for about 10% of eye-related emergency visits, the estimated incidence varies by population and depends on how they are defined and the activities involved in the mechanism of injury.
Corneal abrasions are common, accounting for 12-13% of new cases seen in 2 different eye emergency units in the United Kingdom.[15] They are also frequent presenting problems in general hospital emergency departments. Trauma accounted for 66% of these cases, or 4% of all cases; corneal abrasions or corneal or conjunctival foreign bodies accounted for 80% of eye trauma cases, or 3% of all cases. These erosions may be caused by damage to the basement membrane (to which the newly healed overlying cells do not adhere well) and subsequent slough due to mild hypoxia that occurs during sleep. Abnormal corneal epithelial wound healing in partial-thickness removal of limbal epithelium. Eye injuries in an Italian urban population: report of 10,620 cases admitted to an eye emergency department in Torino. Effects of morphine on corneal sensitivity and epithelial wound healing: implications for topical ophthalmic analgesia.
Porcine collagen corneal shield treatment of persistent epithelial defects following penetrating keratoplasty.
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In case of trademark issues please contact the domain owner directly (contact information can be found in whois). However, deep corneal involvement may result in facet formation in the epithelium or scar formation in the stroma. Spontaneous corneal abrasions may be associated with map-dot-fingerprint dystrophy or recurrent corneal erosion syndrome.
Patching the eye is a traditional measure, but it is not supported by research and should not be performed in patients at high risk of eye infection. It is innervated primarily by the ophthalmic division of the trigeminal nerve as well as the oculomotor nerve. Corneal epithelial cells are continuously shed into the tear pool, and they are simultaneously replenished by cells moving centrally from the limbus and anteriorly from the basal layer of the epithelium. Cell proliferation, which is independent of cell migration, begins approximately 24 hours after injury. The observation of limbal pigment migrating onto the clear cornea provides additional evidence of this process. Some authors believe that conjunctival and limbal epithelial cells may contribute to the regeneration of corneal epithelium. However, proliferation occurs at high levels in the bulbar conjunctiva, which contains few if any goblet cells. Last, healing of the corneal epithelial wound is not complete until the newly regenerated epithelium has firmly anchored itself to the underlying connective tissue. With a contact lens, overnight swelling increases to an average of 15%, and gross stromal edema can be present on awakening.
In these situations, acute epithelial hypoxia impairs attachment of the epithelium to the Bowman membrane. More often, the lens becomes slightly dehydrated at the end of the day because of insufficient blinking. Decreased tear production under general anesthesia, proptosis, and a poor Bell phenomenon may worsen corneal exposure, requiring eyelid suturing in some susceptible patients. One third of eye injuries resulted in the inability of workers to resume normal duties for at least 1 day. Patients typically are awakened in the early morning by the same symptoms as those of a corneal abrasion. Close follow-up care is necessary, however, because of the ever-present danger of the abrasion progressing to an ulcer.
Update: do ophthalmic nonsteroidal anti-inflammatory drugs reduce the pain associated with simple corneal abrasion without delaying healing?.
Customize your Medscape account with the health plans you accept, so that the information you need is saved and ready every time you look up a drug on our site or in the Medscape app. Severe corneal injuries can also involve the deeper, thicker stromal layer; in this situation, the term corneal ulcer may be used. Marked proliferative responses in the conjunctiva after a central corneal epithelium abrasion have been described. The apparent decrease in cell number is more likely the result of mucin secretion rather than actual loss of goblet cells. In some patients, induced corneal swelling can be sufficient to cause bullae; these can rupture, leading to epithelial defects. Easily compare tier status for drugs in the same class when considering an alternative drug for your patient.
Symptoms can range from very aggressive to asymptomatic and non-progressive, even within the same family.
After the contact lens is removed, the patient may feel discomfort; however, no pain occurs when the lens is worn because it acts as a bandage. Patients who incompletely blink and those who work in a dry environment, read most of the day, or look at TV or computer screens should be warned about this complication.




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