Phlyctenule

A phlyctenule (also called phlycten^[1]) is a characteristic nodular affection occurring as an allergic response of the conjunctival and corneal epithelium to some endogenous allergens to which they have become sensitized.

Etiological factors

1. Tuberculous protein
2. Staphylococcus protein-most common
3. Others- Moraxella axenfeld bacillus and certain parasites.

Predisposing factors

1. Age—3-15 yrs
2. Sex—F>M
3. Under nourished
4. Living conditions- over crowded and unhygienic conditions
5. Season- more in spring and summer

Symptoms

1. mild discomfort and irritation
2. itching
3. reflex watering
4. associated mucopurulent conjunctivitis due to secondary bacterial infection

signs

1. Phlyctenular conjunctivitis presents in three forms-

        a. simple-
         -most common
         -presence of pinkish white nodule surrounded by hyperemia on the bulbar conjunctiva, usually near the limbus.
         -mostly presents as solitary nodule,sometimes more may be present.
         -in a few days, nodule ulcerates at apex, which later on gets epithelialised.
         -rest of conjunctiva is normal.
        b. necrotising
         -presence of very large phlycten with necrosis and ulceration.
         -leads to severe pustular conjunctivitis.
        c. miliary
         -multiple phlyctens arranged haphazardly or in the form of ring around limbus(ring ulcer)

2. Lacrimation without discharge

3. may be associated with enlarged tonsils and cervical nodes

4. phlyctenular keratitis:

        corneal involvement may present as:-
       1. ulcerative PKC
          a.sacrofulous ulcer
          b.fascicular ulcer
          c.miliary ulcer
       2. diffuse infiltrative keratitis

Treatment

1. local-

    -topical steroid-dexamethasone or betamethasone
    -antibiotic drops and ointment
    -atropine 1% eye ointment once daily if cornea is involved

1. specific-

    -Tuberculosis should be excluded by Chest x-ray, mantoux test, ESR and if necessary full dose ATT should be given.
    -Septic focus in the form of tonsillitis, adenoiditis, teeth caries should be treated by antibiotics and necessary surgical interventions.
    -parasitic infestation should be ruled out and treated if necessary.

1. General-

    - high protein diet and Vit. A, C, and D supplementation.

See also

• Blepharitis
• Conjunctivitis
• Corneal ulcer

References

1. http://www.stacommunications.com/journals/cme/2002/05-May/conjunctives.pdf