Phlyctenule

A phlyctenule (also called phlycten) 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. staphyloccus 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 crowwded and unhygienic conditions
  5. season- more in spring and summer

Symptoms-

  1. mild discomfort and irritation
  2.reflex watering
  3. 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.
  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

2. 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.

3. General-

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

See also

• Blepharitis
• Conjunctivitis
• Corneal ulcer