Phlyctenule conjunctival

Figure 25-32 Conjunctival phlyctenule arrow ) in inter-palpebral aperture. (Courtesy William Wallace, O.D.)...

Along with the phlyctenule, examination often reveals conjunctival hyperemia, a scanty watery discharge, and diffuse corneal staining. If the phlyctenule is caused by Staphylococcus, an associated blepharitis is common. Phlyctenules typically last from 10 to 14 days and occur primarily in children, with girls more frequently affected than boys. 

Conjimctival phlyctenules appear on the limbus or bulbar conjimctiva. Lesions are usually close to the limbus near the free lid margin but can present anywhere on the bulbar conjimctiva. They rarely affect the palpebral conjunctiva. They often are surrounded by hyperemia. Corneal phlyctenules typically start at the limbus and are accompanied by a leash of conjunctival vessels (Figure 26-41). Initially, the overlying epithelium is intact... 

Figure 26-41 (A) Corneal phlyctenule accompanied by a leash of conjunctival vessels. (B) Corneal phlyctenule. (Courtesy of Pat Caroline.)...

Although phlyctenules can resolve spontaneously, they usually ulcerate and scar before resolution. To prevent scarring, treatment should include 1% prednisolone acetate, one drop every 2 to 4 hours for 3 to 4 days. Also, instill prophylactic antibiotic ointment or drops, such as bacitracin, erythromycin, or polymyxin B/trimethoprim, into the conjunctival sac four times a day and continue as... 

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