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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.

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