Phlyctenule corneal

If a significant inflammatory component or a response to bacterial exotoxin hypersensitivity in the fiarm of marginal corneal infiltrates or phlyctenules is present, treatment may require concurrent topical steroid therapy. When chronic dacryocystitis is involved, treatment should include irrigation of the lacrimal system with trimethoprim-polymyxin B or gentamicin. Adjunctive systemic antibiotic therapy may also be required (see Chapter 24). 

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.)...

The vessels associated with the phlyctenule also migrate toward the center of the cornea and produce focal neovascularization. Triangular corneal scars with their base at the limbus often form as phlyctenules heal. These scars can be vascularized. Scarring in the central cornea can decrease visual acuity if the phlyctenulosis is long-standing. Corneal perforation in phlyctenulosis is rare but has been reported. 

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