Phlyctenular Keratoconjunctivitis

Phlyctenular Keratoconjunctivitis

  • Inflammation of the conjunctiva and cornea induced by microbial antigens.
  • Causative organisms include: Staphylococcus aureus, Mycobacterium tuberculosis, Chlamydia sp. Candida albicans and parasites (Ascaris lumbricoides, Ancylostoma duodenale).

Clinical Features:

  • Symptoms: foreign body sensation, photophobia, redness, irritation and tearing.
  • Signs:
    • Single or multiple pinkish conjunctival or limbal nodules 0.5-3 mm in diameter
    • Usually surrounded by conjunctival hyperemia
    • Commonly develops ulcerative necrotic lesion over several days
    • May be triggered by active Staph. blepharitis
    • May heal rapidly over 2 weeks without conjunctival scarring
    • Corneal phlyctenulosis may cause ulceration and tend to migrate centrally, may develop scarring and decreased vision after healing

Work Up:

  • Culture of the lids in patients with active blepharitis
  • Conjunctival and corneal scraping may be indicated
  • PPD with anergy panel (tuberculin skin) test
  • Chest X-Ray if PPD is positive

Management: 

  • Lid hygiene for Staph. blepharitis.
  • Topical antibiotic with adjuvant topical steroids.
  • Systemic antimicrobial therapy such as doxycycline for severe blepharitis.
  • Cycloplegic drop for patients with photophobia or severe corneal involvement.