phlyctenulosis

Etiology

• eye infection
  • Staphulococcus aureus
  • Coccidioides immitis
  • Candida albicans
  • Chlamydia
• acne rosacea
• idiopathic (rare)

Epidemiology

• most common in women < 20 year of age who live in crowded or impoverished quarters

Pathology

• nodular inflammation of the peri-limbal tissues secondary to an allergic hypersensitivity response of the cornea
• phlyctenules are the lesion of phlyctenulosis
  • conjunctival phlyctenules
    • 1-3 mm hard, triangular, slightly elevated, yellowish-white noduled surrounded by a hyperemic response
    • in the vicinity of the inferior limbus
    • lesions tend to be bilateral
  • corneal phlyctenules
    • usually begin adjacent to the limbus as a white mound, with a radial pattern of vascularized conjunctival vessels
    • may migrate toward the center of the cornea, progressing as a gray-white, superficial ulcer surrounded by infiltrate in the areas where the lesion has been
• infitrates consist of lymphocytes, histocytes & plasma cells
• neutrophils are found in necrotic lesions
• lesions form as a result of a delayed hypersensitivity reaction to pathogen antigens

Clinical manifestations

• tearing
• ocular irritation
• mild to severe photophobia

Diagnostic procedures

• ophthalmoscopy
  • slit lamp examination
• PPD if tuberculosis suspected

Radiology

• chest X-ray to rule out tuberculosis if indicated

Management

• eyelid hygiene
  • eyelid scrubs 2-3 times per day + artificial tears
  • ophthalmic glucocorticoid, prednisolone acetate (Pred Forte) or glucocorticoid-antibiotic combination for more severe cases
• cycloplegia may be necessary if there is an associated iritis
• if due to Staphylococcus or acne rosacea, oral tetracycline or erythromycin, along with topical antibiotic ointments such as bacitracin or erythromycin
• topical metronidazole (Metrogel) applied to the skin TID is also effective

More general terms

• eye infection (ocular infection)