Phlyctenular Conjunctivitis

The Case

L.F.J 14/F Malate, Manila

CC: Redness, OD

History of Present Illness

Redness, OD

(+) itchiness and increased lacrimation

No consult done and no medication taken

Persistence of the above sx

Whitish spot on the sclera, OD

Redness, OS

No consult done

“Artificial tears” eye drops, OU

Persistence of redness, OD

Consult at OMMC

1 Week PTC

2 Days PTC

Few Hours PTC

The Case

(+) complete immunization

(-) BA, PTB, allergy to foods/medications

(-) previous hospitalization/ surgical operation

No previous eye trauma or disease.

Past Medical History Eye History

The Case

(-) HPN, DM, PTB, BA, Allergy

2nd year HS student

Non-smoker Non-alcoholic

beverage drinker

Family Medical History Personal and Social History

Physical Examination

Conscious Coherent Not in distress

OD: 20/20 – 1 OS: 20/20

General Visual Acuity

Physical Examination

External Eye Exam

Extra-Ocular Muscles

Physical Examination

Fundoscopy

Slit Lamp

OD (+) ROR, CM, DDB, CDR 0.3, AVR 2:3, (-) H/E OS (+) ROR, CM, DDB, CDR 0.3, AVR 2:3, (-) H/E

T/C Phlyctenular Conjunctivitis, OD

Assessment:

Differential Diagnoses

Pingueculae are characterized by yellowish, slightly raised, interpalpebral lipid-like deposits in the nasal and temporal limbal conjunctiva

Pingueculitis occurs when a pinguecula becomes acutely inflamed

Pingueculitis

Differential Diagnoses

A thin-walled sac or vesicle that contains fluid

This vesicle may develop either on or under the conjunctiva

Conjunctival Inclusion Cyst (Retention Cyst)

Phlyctenular Conjunctivitis Phlyctenular

Keratoconjunctivitis; Phlyctenulosis

A hypersensitivity reaction of the cornea and conjunctiva to bacterial antigens

Discrete nodular areas of corneal or conjunctival inflammation

Phlyctenular Conjunctivitis Causative organisms include:

Staphylococcus aureus Mycobacterium tuberculosis Chlamydia sp. Candida albicans Parasites (Ascaris lumbricoides,

Ancylostoma duodenale).

Phlyctenular Conjunctivitis Patients have multiple lesions, consisting of

small yellow-gray nodules (phlyctenules) that appear at the limbus, on the cornea, or on the bulbar conjunctiva and persist from several days to 2 wk.

Phlyctenular Conjunctivitis Conjunctiva

nodules ulcerate but heal without a scar. Cornea

severe lacrimation, photophobia, blurred vision, aching, and foreign body sensation

Frequent recurrence, especially with secondary infection, may lead to corneal opacity and neovascularization with loss of visual acuity

Phlyctenular Conjunctivitis Work up:

Culture of the lids in patients with active blepharitis

Conjunctival and corneal scraping may be indicated

PPD (tuberculin skin) test Chest X-Ray

Phlyctenular Conjunctivitis Management:

Lid hygiene for Staph. blepharitis. Moderate to severe cases require topical

steroids or steroid-antibiotic combinations. Systemic antimicrobial therapy such as

doxycycline for severe blepharitis. Cycloplegic drop for patients with

photophobia or severe corneal involvement.

Thank You!

End