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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
Special laboratory:
- 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
General
eye infection (ocular infection)
References
- Handbook of ocular disease management: Phlyctenulosis
http://cms.revoptom.com/handbook/sect3e.htm