Merck Manual

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Phlyctenular Keratoconjunctivitis

(Phlyctenular Conjunctivitis; Phlyctenulosis)

By

Melvin I. Roat

, MD, FACS, Sidney Kimmel Medical College at Thomas Jefferson University

Medically Reviewed Aug 2022 | Modified Sep 2022
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Phlyctenular keratoconjunctivitis, a hypersensitivity reaction of the cornea and conjunctiva to bacterial antigens, is characterized by discrete nodular areas of corneal or conjunctival inflammation.

Phlyctenular keratoconjunctivitis results from a hypersensitivity reaction to bacterial antigens, primarily staphylococcal, but tuberculosis (TB), Chlamydia, and other agents have been implicated. It is more common among children. Many patients also have blepharitis Blepharitis Blepharitis is inflammation of the eyelid margins that may be acute or chronic. Symptoms and signs include itching and burning of the eyelid margins with redness and edema. Diagnosis is by history... read more Blepharitis .

Patients have multiple lesions, consisting of small yellow-gray nodules (phlyctenules) that appear at the limbus, on the cornea, or on the bulbar conjunctiva and persist from several days to 2 weeks. On the conjunctiva, these nodules ulcerate but heal without a scar. When the cornea is affected, severe lacrimation, photophobia, blurred vision, aching, and foreign body sensation may be prominent. Frequent recurrence, especially with secondary infection, may lead to corneal opacity and neovascularization with loss of visual acuity.

Treatment for nontuberculous cases is with a topical corticosteroid–antibiotic combination. Treatment reduces the pain within hours and prevents scarring and decreased vision. If patients have seborrheic blepharitis Blepharitis Blepharitis is inflammation of the eyelid margins that may be acute or chronic. Symptoms and signs include itching and burning of the eyelid margins with redness and edema. Diagnosis is by history... read more Blepharitis , eyelid scrubs may help prevent recurrence.

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NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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