phlyctenular conjunctivitis

Last reviewed 01/2018

• 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 There is a tendency to ulcerate and dissappear, but frequently, the lesion is superceded by another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