Phlyctenular conjunctivitis

• this is a delayed hypersensitivity reaction to microbial proteins - e.g. the tubercle bacillus, staphylococcus, chlamydia yeasts and Candida albicans. It occurs in undernourished children living in overcrowded, unhygienic conditions
  
  
• clinical features:
  • the major feature are phlyctens - raised hard red, 1-3mm, nodules near the limbus and accompanied by a zone of hyperemia. There is a tendency to ulcerate and disappear, but frequently, the lesion is superseded by another
  • symptoms are mild but once the cornea is involved (corneal phlycenules develop as a grey amorphous infiltrate), there is pain, lacrimation and photophobia. These are most marked in tuberculo-protein induced disease

Management:

• seek expert advice
• steroid drops may provide symptomatic relief but it is more important to treat the underlying disease and improve the diet and surroundings of the patient
• when found should be further investigated to discover an underlying pathology. Tuberculosis should always be excluded. Specialist centre referral may be required

Reference

1. Rohatgi J, Dhaliwal U. Phlyctenular Eye Disease: A Reappraisal. Jpn J Ophthalmol. 2000;44:146–150.