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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.
- Tuberculous protein
- Staphyloccus protein-most common
- Others- moraxella axenfeld bacillus and certain parasites.
- age—3-15 yrs
- under nourished
- living conditions- over crowded and unhygienic conditions
- season- more in spring and summer
- mild discomfort and irritation
- reflex watering
- associated mucopurulent conjunctivitis due to secondary bacterial infection
- 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(ring ulcer)
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
-topical steroid-dexamethasone or betamethasone -antibiotic drops and ointment -atropine 1% eye ointment once daily if cornea is involved
-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.
- high protein diet and Vit. A, C, and D supplementation.
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