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Conjunctiva -  PIGMENTATION OF THE CONJUNCTIVA Lecture 28 of 32  NEXT»

1. Blood pigment

 *A. After subconjunctival hemorrhage-red or later fine brown spots
 B. Yellow tinge of malaria, blackwater fever, or yellow fever
 C. Pigmentary limbal ring associated with senile, traumatic, or diseased conditions

2. Bile pigments (yellow)-obstructive or hemorrhagic jaundice
3. Melanin pigmentation 

 A. Acanthosis nigricans
 *B. Addison disease (adrenal cortical insufficiency)
 C. Alcaptonuric ochronosis
 D. Chlorpromazine (Thorazine)
 E. Endogenous ochronosis
 F. Keratomalacia
 G. Trachoma
 *H. Use of epinephrine or epinephrine bitartrate, borate, and hydrochloride
 I. Vernal conjunctivitis
 J. Vitiligo (leukoderma)-increased conjunctival pigmentation
 K. Xeroderma pigmentosum

4. Drugs, including the following:

acid bismuth sodium
    tartrate
Alcian blue
amiodarone
amodiaquine
amphotericin B
antimony lithium
    thiomalate
antimony potassium
    tartrate
antimony sodium
    tartrate
antimony sodium
    thioglycollate
antipyrine
bismuth carbonate(?)
bismuth oxychloride(?)
bismuth salicylate(?)
bismuth sodium tartrate
bismuth sodium
     thioglycollate (?)
bismuth sodium
    triglycollamate(?)
bismuth subcarbonate
bismuth subsalicylate
captopril
chloroquine
chlortetracycline
chrysarobin
clofazimine
colloidal silver
demeclocycline
diethazine
doxycycline
enalapril
ethopropazine
ferrocholinate
ferrous fumarate
ferrous gluconate
ferrous succinate
ferrous sulfate
fluorescein
gold AU 198
gold sodium thiomalate
gold sodium thiosulfate
hydroxychloroquine
iron dextran
iron sorbitol
ketoprofen
methacycline
methylene blue
minocycline
minoxidil
oxytetracycline
penicillamine
polysaccharide iron
     complex
quinacrine
rifabutin
rifampin silver nitrate
    silver protein
rose bengal
sodium
    antimonylgluconate
stibocaptate
stibophen
tetracycline
trypan blue
vitamin A

5. Foreign substances such as silver (argyrosis), iron (siderosis), copper (chalcosis), arsenic (arsenic melanosis), gold (chrysiasis), aluminum, quinones, aniline dyes, and eye cosmetics containing carbon black
*6. Benign melanosis-overactivity of melanocytes

 A. Epithelial-congenital or acquired, for example., following radiation or use of  chemicals (arsenic); in Addison disease; because of chronic conjunctivitis  (trachoma, vernal conjunctivitis, onchocerciasis, keratomalacia)
 B. Subepithelial-congenital or in association with melanosis oculi or nevus of Ota

7. Neoplasms

 *A. Nevus-most common in children, localized stationary, elevated, cystic, mayor may not have  pigmentation
 *B. Malignant melanoma arising from preexisting nevus, apparently normal  conjunctiva, or from an area of acquired pigmentation (intraepithelial melanoma);  occurs primarily in middle age; diffuse, flat, pigmentation; progressive; no cysts
 C. Secondary melanotic tumors
 D. Incidentally pigmented tumors, such as a melanocarcinoma
 E. Secondary metastatic tumors from lung or breast

8. Ocular causes, including the following:

 A. Apocrine adenocarcinomas
 B. Foreign bodies
 C. Hematic cysts
 D. Moll gland cystadenomas
 E. Staphylomas
 F. Subconjunctival hematomas

Cheskes J, et al. Ocular manifestations of alkaptonuric ochronosis. Arch Ophthalmol 2000; 118:724-727.

Fraunfelder FT, Fraunfelder FW. Drug-induced ocular side effects. Woburn, MA: Butterworth-Heinemann, 2001.

Linebarger EJ, et al. Conjunctival aluminum deposition following pneumatic cryopexy. Arch Ophthalmol 1999; 117:692.

Roy FH. Ocular syndromes and systemic diseases. 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.

Seregard S. Conjunctival melanoma. Surv Ophthalmol 1998; 42:32l-350.


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