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What Is Phlyctenular Keratoconjunctivitis?

Phlyctenular keratoconjunctivitis is an inflammatory condition in which small, raised nodules (phlyctenules) develop on the conjunctiva or corneal limbus as a hypersensitivity reaction to microbial antigens. It is most often linked to staphylococcal lid disease, but tuberculosis and other organisms can also be triggers. Children and young adults are commonly affected. Symptoms include redness, tearing, foreign body sensation, and light sensitivity. Corneal phlyctenules can ulcerate and leave small scars that affect vision if they cross the visual axis.

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What Is Phlyctenular Keratoconjunctivitis?

Phlyctenular keratoconjunctivitis is an inflammatory condition in which small, raised nodules (phlyctenules) develop on the conjunctiva or corneal limbus as a hypersensitivity reaction to microbial antigens. It is most often linked to staphylococcal lid disease, but tuberculosis and other organisms can also be triggers. Children and young adults are commonly affected. Symptoms include redness, tearing, foreign body sensation, and light sensitivity. Corneal phlyctenules can ulcerate and leave small scars that affect vision if they cross the visual axis.

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Causes and Associations of Phlyctenular Keratoconjunctivitis

The condition represents a delayed type hypersensitivity reaction to bacterial proteins, especially from Staphylococcus on the lids or Mycobacterium tuberculosis in some regions. Chronic blepharitis and poor lid hygiene are common backgrounds. In areas where tuberculosis is prevalent, systemic infection must be considered and evaluated. Other organisms, such as intestinal parasites, have also been implicated. Identifying and treating the underlying source of antigen exposure helps prevent recurrences.

Symptoms and Clinical Features

Patients present with localized redness, tearing, and a gritty feeling, often in one sector of the eye. Photophobia can be marked when corneal involvement is present. On slit lamp exam, a small, gray white nodule with surrounding hyperemia is seen at the limbus or on the bulbar conjunctiva. When on the cornea, the lesion can migrate centrally and sometimes ulcerate at its leading edge. Associated signs include staphylococcal blepharitis, lid crusting, and, in tubercular cases, evidence of systemic disease.

How Is Phlyctenular Keratoconjunctivitis Diagnosed?

Diagnosis is clinical and based on the appearance of phlyctenules plus a history of lid disease or risk factors for tuberculosis. The eye doctor examines the eyelid margins for collarettes, meibomian dysfunction, and signs of chronic infection. In suspected tubercular cases, chest imaging and tests such as tuberculin skin testing or interferon gamma release assays are ordered. Other causes of nodular or ulcerative keratitis are considered and ruled out. Response to therapy and control of lid disease support the diagnosis.

How Is Phlyctenular Keratoconjunctivitis Managed?

Treatment combines control of the hypersensitivity reaction with management of the underlying source of antigens. Topical steroids or steroid antibiotic combinations are used to reduce inflammation around phlyctenules under close supervision. Lid hygiene, warm compresses, and topical or systemic antibiotics help treat staphylococcal blepharitis. In tubercular cases, appropriate systemic antitubercular therapy is started in coordination with infectious disease specialists. Protecting the cornea with lubricants and monitoring for ulceration reduces the risk of scarring.

FAQs About Phlyctenular Keratoconjunctivitis

Is phlyctenular keratoconjunctivitis an infection?

It is usually not a direct infection of the cornea, but a hypersensitivity reaction to bacterial or tubercular antigens. Even so, controlling the underlying source of antigens, such as lid infection or tuberculosis, is very important.

Can phlyctenular keratoconjunctivitis affect both eyes?

Yes, it can be unilateral or bilateral. Children with severe lid disease or systemic infection sometimes develop lesions in both eyes, so both are examined carefully.

Will the nodules leave permanent scars on the cornea?

Conjunctival phlyctenules usually heal without major visual impact, but corneal lesions can leave small scars, especially if they ulcerate or cross the visual axis. Early treatment helps limit scarring.

Can phlyctenular keratoconjunctivitis come back after treatment?

Recurrences are common if lid disease or systemic infection is not fully addressed. Ongoing lid hygiene and completion of any needed systemic therapy reduce the chance of new episodes.