From the Guidelines
Findings under the eyelids and during conjunctival examination can include a range of abnormalities, such as conjunctival hyperemia, papillomatous or sessile nodules, and mucopurulent discharge.
Key Findings
- Conjunctival injection and discharge are common findings in various types of conjunctivitis, including bacterial, viral, and allergic conjunctivitis 1.
- Papillary hypertrophy of the tarsal conjunctiva can be seen in giant papillary conjunctivitis (GPC) and floppy eyelid syndrome 1.
- Mucopurulent discharge and coagulum can be found in giant fornix syndrome, which is characterized by an enlarged superior fornix with a coagulum of mucopurulent material and ptosis 1.
- Neoplastic lesions, such as sebaceous carcinoma and ocular surface squamous neoplasia, can also be found under the eyelids and during conjunctival examination, and may present with a hard nodular mass, yellowish discoloration, or conjunctival scarring 1.
- Melanoma can present as a painless, flat or nodular, brown or fleshy-pink lesion on the bulbar or palpebral conjunctiva or caruncle 1.
Clinical Signs
- Conjunctival hyperemia and papillomatous or sessile nodules can be seen in ocular surface squamous neoplasia and other types of conjunctivitis 1.
- Mucoid discharge and papillary hypertrophy can be found in giant papillary conjunctivitis (GPC) and floppy eyelid syndrome 1.
- Ptosis and superior hyperemia can be seen in giant fornix syndrome and floppy eyelid syndrome 1.
From the Research
Findings Under the Eyelids
- A firm vascularized nodule can develop in the lower eyelid, as seen in a case of bacillary angiomatosis 2
- Eyelid oedema can be a symptom of ligneous conjunctivitis, which may resemble preseptal cellulitis 3
- Floppy eyelids and lacrimal gland prolapse have been associated with sleep apnea syndrome 4
Conjunctival Examination Findings
- Conjunctival chemosis can occur due to exposure of the lacrimal caruncle, and can be resolved by debulking the caruncle 5
- Ligneous conjunctivitis can cause multiple, wood-like fibrinous pseudomembranes on the conjunctiva 3
- Conjunctival petechiae can develop post-mortem due to a prone position of the body, and can be influenced by factors such as examination method and resuscitation attempts 6
- Bacillary angiomatosis can cause an abnormal vascular proliferation and a mixed inflammatory infiltrate on the conjunctiva 2
- Sleep apnea syndrome has been associated with reduced tear film break-up time and ocular irritation symptoms are rare in patients with SAS 4