Merrill Stass-Isern

Disorders of the Conjunctiva

The conjunctiva is a transparent mucous membrane lining the inner surface of the eyelids and the surface of the globe as far as the limbus. It is richly vascular, supplied by the anterior ciliary and palpebral arteries. There is a dense lymphatic network, with drainage to the preauricular and submandibular nodes corresponding to that of the eyelids. It has a key protective role, mediating both passive and active immunity. Clinically, it is subdivided into the following:

Utility of MR imaging in cat-scratch neuroretinitis

About 80% of cat-scratch disease (CSD) infections occur in children, and CSD neuroretinitis (optic neuropathy with retinal exudates in a “macular star” pattern) mostly occurs in children and young adults. A recent study suggested that CSD optic neuropathy has specific features on MR imaging. However, MR imaging findings in CSD neuroretinitis are not well described in the pediatric literature. We present a patient with CSD neuroretinitis in whom these specific MR imaging features preceded the macular star, a funduscopic finding strongly suggestive of neuroretinitis. This case demonstrates how knowledge of these features is important in the appropriate diagnostic work-up of optic neuropathy. MR imaging also incidentally revealed neuritis of another cranial nerve in the auditory canal—a rare manifestation of CSD.