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By N. R. Galloway BA, MB, ChB, DO, FRCS, MD (auth.)

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Example text

Such early degenerative changes are extremely common in all climates as a natural ageing phenomenon, but under suitable conditions the heaped-up tissue spreads onto the cornea, drawing a triangular band of conjunctiva with it. The eye becomes irritable due to associated conjunctivitis and in worst cases the degenerative plaque extends across the cornea and affects the vision. The early stage of the condition, which is common and limited to a small area of the conjunctiva, is termed a pingueculum and the more advanced lesion spreading onto the cornea is known as a pterygium.

The diagnosis is usually evident from the history but conjunctival scrapings show the presence of eosinophils. Patients with atopic keratoconjunctivitis have a higher risk than normal for the development of herpes simplex keratitis and the condition is also associated with the rare corneal dystrophy known as keratoconus or conical cornea. Vernal Conjunctivitis (spring catarrh). Some children with an atopic history may develop a specific type of conjunctivitis characterised by the presence of giant papillae under the upper lid.

Recurrent lid infections may raise the suspicion of diabetes mellitus but in practice this is rarely found to be an underlying cause. Eyelid infections such as these very rarely cause any serious problems other than a few days off work, and it is extremely unusual for the infection to spread and lead to orbital cellulitis. Recurrent swelling of the eyelid in spite of incision and curettage may indicate the need for a lid biopsy, but in practice tumours of the eyelid such as carcinoma of the meibomian gland are extremely rare.

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