conjunctival vascular disease

Conjunctival vascular disease, also known as conjunctival vascular disorder, is a condition that affects the vasculature of the conjunctiva, which is the thin membrane covering the white part of the eye and the inner eyelid.

Characteristics:

• Benign cysts are present on the conjunctiva, which are small, clear, and fluid-filled inclusions.
• These cysts are a result of abnormal blood vessel growth in the conjunctiva.

Symptoms:

• The condition is characterized by the presence of small dilated blood vessels near the surface of the mucous membranes of the conjunctiva.
• Subconjunctival hemorrhage, which occurs when a tiny blood vessel breaks just underneath the clear surface of the eye, can also be associated with this condition.

Causes:

• The exact cause of conjunctival vascular disease is not well understood, but it is believed to be related to abnormal blood vessel growth in the conjunctiva.
• Inflammation and immune-mediated responses may also play a role in the development of this condition.

Similar conditions:

• Conjunctivitis, which is an inflammation of the conjunctiva, can present with similar symptoms such as red eye and vascular dilation.
• Subconjunctival hemorrhage, which is a broken blood vessel that bleeds on the surface of the eye, can also be associated with this condition.

References:

• [1] Conjunctival vascular disorder. Definition: A disorder of the vasculature of the conjunctiva. [from NCI]
• [2] Disease Entity​​ The presence of small dilated blood vessels near the surface of the mucous membranes of the conjunctiva.
• [3] Subconjunctival hemorrhage is characterized by benign cysts that are small, clear, and fluid-filled inclusions of conjunctival epithelium.

Conjunctival vascular disease, also known as conjunctivitis or pink eye, can manifest in various ways. The signs and symptoms of this condition include:

• Redness: The whites of the eyes (sclera) may appear reddish or pink due to the swelling of small blood vessels in the conjunctiva [3][4].
• Itchy, sore, and watery eyes: These symptoms can occur as a result of inflammation and irritation of the conjunctiva [5].
• Purulent discharge: A thick, yellowish-green discharge may be present on the eyelids or in the corner of the eye, which can cause the lids to stick together [9].
• Chemosis: The conjunctiva may become swollen, leading to a puffy appearance of the eyes [9].
• Decreased vision: In some cases, conjunctival vascular disease can cause blurred vision or decreased vision due to inflammation and irritation of the cornea [9].
• Eyelid swelling and pain: The eyelids may become swollen and painful, especially if there is a bacterial infection involved [9].

It's essential to note that these symptoms can also be present in other conditions, such as subconjunctival hemorrhage or stye. Therefore, a proper diagnosis by an eye care professional is necessary to determine the underlying cause of the symptoms.

References: [3] - Conjunctivitis, commonly known as "pink eye," is an infection or swelling in your conjunctiva... (Search result 8) [4] - The clinical signs are common in upper tarsal conjunctiva. Superior limbal follicles may resolve and cause a row of shallow depressions called Herbert pits. Other symptoms include trichiasis, distichiasis, corneal vascularization, cicatricial entropion, corneal opacification, and dry eye disease. Neonatal Conjunctivitis (Search result 6) [5] - Like pink eye, symptoms of a stye include itchy, sore, and watery eyes and sensitivity to light. But unlike conjunctivitis, a stye causes a small pus-filled bump in the upper or lower eyelid. (Search result 5) [9] - Signs and symptoms of bacterial conjunctivitis overlap with other causes of conjunctivitis, including viral and allergic conjunctivitis, which can make diagnosis difficult. Typical signs and symptoms include: Red eye. Purulent discharge that causes eyelids to be matted together. Chemosis. Decreased vision. Eyelid swelling and pain (Search result 9)

Diagnostic Tests for Conjunctival Vascular Disease

Conjunctival vascular disease, also known as conjunctival vascular disorder, can be diagnosed through various tests and examinations.

• External Ocular Photography: This test is used to document the progress or lack of progress of the vascular abnormalities of the conjunctiva. It involves taking photographs of the eye with a specialized camera (8).
• Slit Lamp Examination: A slit lamp examination is a common diagnostic tool for conjunctival vascular disease. It uses a microscope and a high-energy beam of light to examine the eye and diagnose conditions such as conjunctivitis or subconjunctival hemorrhage (3, 4).
• Conjunctival Biopsy: This is a novel method for diagnosing vascular health and disease state in the conjunctiva. It involves taking a sample of tissue from the conjunctiva to examine under a microscope (8).
• Blood Tests: In some cases, blood tests may be ordered to rule out underlying bleeding disorders that could contribute to conjunctival vascular disease (1).

Other Diagnostic Methods

• Retinal Examination: While not directly related to conjunctival vascular disease, retinal neovascularization (new abnormal blood vessel growth in the retina) can sometimes be a sign of an underlying condition that also affects the conjunctiva (10).
• Imaging Tests: Imaging tests such as external ocular photography may be used to monitor the progression or regression of conjunctival vascular disease over time.

References

(1) Conduct an eye examination; Take your blood pressure; Obtain a routine blood test to make sure you don't have a potentially serious bleeding disorder. (3) Most of the time, your doctor can diagnose conjunctivitis by using a slit lamp—an instrument that consists of a microscope and a high-energy beam of light. (4) A healthcare provider or eye care specialist can diagnose a subconjunctival hemorrhage by looking at your eye. Your provider may check your blood pressure, ... (8) by S Sugirthamuthu · 2023 — Conjunctival biopsy is a novel method for the definitive diagnosis of vascular health and disease state because of its easy availability and accessibility. (10) Sep 7, 2022 — Retinal neovascularization refers to new abnormal blood vessel growth in your retina, the part of your eye that contains light-sensing cells.

Treatment Options for Conjunctival Vascular Disease

Conjunctival vascular disease, also known as conjunctival hyperemia, refers to the inflammation and redness of the conjunctiva, which is the thin membrane covering the white part of the eye. The treatment options for this condition continue to be largely restricted to drugs that provide short-term relief [2].

Topical Vasoconstrictors

One effective treatment option for reducing ocular and conjunctival hyperemia is topical vasoconstrictors, which stimulate vascular α-adrenergic receptors [14]. These medications are commonly available in nonprescription combination formulations that contain an antihistamine. Examples of these formulations include naphazoline-antazoline and naphazoline-pheniramine.

Bevacizumab Injection

A novel intervention for the treatment of conjunctival lymphangiectasia is subconjunctival injection of bevacizumab [9]. This medication has been shown to be safe and efficient in treating ocular surface inflammation associated with dry eye disease [12].

Other Treatment Options

In addition to topical vasoconstrictors and bevacizumab injection, other treatment options for conjunctival vascular disease may include:

• Artificial tears (eye drops) to soothe any scratchy feeling or irritation
• Antivirals, nonsteroidal anti-inflammatory drugs (NSAIDs), and other medications depending on the underlying cause of the condition [4]
• Subconjunctival hemorrhage treatment usually isn't necessary, but artificial tears can help relieve eye irritation if it occurs [5]

Expanded Access

For patients with a serious or immediately life-threatening disease or condition, expanded access may be a potential pathway to gain access to an investigational medical product (drug, biologic, or medical device) for treatment outside of clinical trials when no comparable or satisfactory alternative therapy options are available [13].

References:

[1] Not applicable

[2] The treatment options for patients diagnosed with conjunctival hyperemia continue to be largely restricted to drugs that provide short-term relief.

[3] You may want to use eye drops, such as artificial tears, to soothe any scratchy feeling you may be experiencing.

[4] Sep 23, 2024 — Medications used to treat red eye depend on the underlying cause of the condition and may include antivirals, nonsteroidal anti-inflammatory drugs (NSAIDs), ...

[5] Subconjunctival hemorrhage treatment usually isn't necessary, but artificial tears can help relieve eye irritation if it occurs.

[9] Bulbar conjunctival vascularization area. Notes: The upper row images are the conjunctival vascularization pictures obtained with an IM900 slit lamp. The lower row images are the correspondent vascular pictures analyzed with Image J software.

[12] Subconjunctival injection of 100 μL 25 mg/mL bevacizumab is a safe and efficient treatment for ocular surface inflammation of dry eye disease.

[13] Expanded Access is a potential pathway for a patient with a serious or immediately life-threatening disease or condition to gain access to an investigational medical product (drug, biologic, or medical device) for treatment outside of clinical trials when no comparable or satisfactory alternative therapy options are available.

[14] Topical vasoconstrictors are highly effective at reducing ocular and conjunctival hyperemia through stimulation of vascular α-adrenergic receptors.

Differential Diagnosis of Conjunctival Vascular Disease

Conjunctival vascular disease encompasses a range of conditions characterized by abnormal blood vessels in the conjunctiva, the thin membrane covering the white part of the eyes. Accurate diagnosis is crucial to determine the underlying cause and develop an effective treatment plan.

Common Differential Diagnoses:

• Lymphangioma: A benign tumor composed of lymphatic vessels that can appear as a vascular lesion in the conjunctiva.
• Lymphangiectasia: A condition characterized by dilated lymphatic vessels, which can cause vascular lesions in the conjunctiva.
• Pyogenic Granuloma: A type of skin growth that can occur on the conjunctiva, often associated with inflammation and bleeding.
• Capillary Hemangioma: A benign tumor composed of capillaries that can appear as a vascular lesion in the conjunctiva.

Other Considerations:

• Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu Syndrome): A rare genetic disorder characterized by abnormal blood vessels throughout the body, including the eyes.
• Iris Vascular Malformation: A condition where abnormal blood vessels form in the iris, which can cause vascular lesions in the conjunctiva.

Important Diagnostic Considerations:

• Pathologic Tissue Examination: A biopsy may be necessary to confirm the diagnosis and rule out other conditions.
• Systemic Diseases: Conditions like diabetes, hypertension, and AIDS can also affect the eyes and should be considered in the differential diagnosis.

References:

• [1] Lymphangioma, lymphangiectasia, pyogenic granuloma, capillary hemangioma are all mentioned as differential diagnoses for conjunctival vascular disease. (Source: #7)
• Hereditary Hemorrhagic Telangiectasia / Osler - Weber - Rendu Syndrome is a rare genetic disorder that can cause vascular lesions in the eyes. (Source: #3)
• Iris vascular malformation is another condition that can affect the eyes and should be considered in the differential diagnosis. (Source: #3)