What is the function of the conjunctiva?

The conjunctiva is a protective covering of the eye and lines its entire surface from the margin of the cornea to the skin of the lids. It has many glands that secrete the watery and mucus part of the tears. It also contains the defense systems of the surface of the eye to fight infections.

What can go wrong with the conjunctiva?

Infections – Being exposed to the environment, this layer is commonly involved in infections – conjunctivitis is usually due to viruses or bacteria and often occurs in epidemics, affecting a number of people. Rarely, chronic infections like TB can also occur.

Allergies – These are also common, especially in people with other allergic tendencies like asthma and skin atopy. In children, this can occur in a recurrent, chronic manner – vernal conjunctivitis, and needs to be treated with care to avoid permanent damage to the eye.

Degenerations – Constant exposure to ultraviolet rays from the sun can result in changes in the exposed conjunctiva – which can form a swelling termed a pingueculum. If this spreads onto the cornea, it can progress to affect sight, and this is termed a pterygium.

Inflammations – In children, a small raised, painful, red swelling can sometimes occur as a reaction to lid margin disease, systemic tuberculosis or worm infestation – phlyctenule. In adults, the conjunctiva can sometimes be involved in systemic inflammations such as sarcoidosis, causing swellings.

Tumors – A black ‘mole’ on the conjunctiva can be a harmless ‘birthmark’ or a more sinister tumor – a careful examination is required. Other tumors may arise from the epithelium of the conjunctiva or from the lymph tissues of the body. All are serious conditions and need prompt treatment.

Miscellaneous – In children with vitamin A deficiency –a foamy, ‘fish scale-like’ appearance is seen – Bitot’s spot. The conjunctiva can be involved in injuries and if the eye is persistently red, an eye exam is warranted as these may sometimes indicate serious systemic diseases, as can persistent bleeding in the conjunctiva.

How will I know if I have conjunctival diseases?

Persistent redness, itching, irritation, and discharge are the common signs of conjunctival problems. A swelling – especially one that is brown or black in color, or a lesion which is spreading across the cornea, should be promptly examined. Any injury to the eye – even if it seems minor, is best evaluated if there is persistent conjunctival redness or change in vision.

How can these be treated?

Infections need to be treated with appropriate medications. However, it is also important to observe good personal hygiene during such infections. These can be easily spread to others by contact or articles of common use. Hence, when you have conjunctivitis avoid close contact with others, wash your hands frequently after you touch your eye, and do not share towels etc with others. Allergies, especially in children need close care and follow-up as the disease and some of the medications used in treatment – steroids, can result in damage to the eye, with unsupervised use. Inflammations need to be thoroughly evaluated as to the cause and appropriate treatment of the underlying condition is also important. Degenerations and tumors often require surgical care.

Recent advances in the management of conjunctival diseases

Newer methods provide prompt diagnosis of infections. Recent advances in allergy management include powerful medications for prompt and effective control of the disease. The surgical procedure of conjunctival autografting provides a very high degree of success in the management of pterygia, and the surgery can now be done quickly and without sutures using fibrin glue. Tumors can be managed effectively using mitomycin C eye drops, which are a useful adjunct to surgical removal.

General health information

When you have conjunctivitis – try and avoid contact with other people and do not use swimming pools to avoid spread of the disease. If your eyes are constantly itchy, red, or have a surface swelling, seek an eye consultation.