Phlyctenular Keratoconjunctivitis (PKC) is nodular inflammation secondary to an allergy, hypersensitivity reaction to a foreign antigen at the cornea and conjunctiva.
Antigens of Staphylococcus aureus and Mycobacterium tuberculosis are most commonly associated.
They are more commonly seen in females than males.
In our practice, we generally see PKC patient’s come along with blepharitis. So check for any lid inflammation.
Eradication of Mycobacterium tuberculosis (TB), makes the current scenario to be rare conjunctivitis.
Phlyctenules can occur anywhere on the conjunctiva but are more common in the interpalpebral fissure and are frequently noted along the limbal region, with a marked injection of the surrounding conjunctival vessels.
The lesions may show some degree of ulceration and staining postive with fluorescein as they progress.
Conjunctival lesions may cause only mild to moderate irritation of the eye, whereas corneal involvement typically may have more severe pain and photophobia.
Recurrent PKC can lead to ulceration, scarring and mild to moderate vision loss.
Corneal phlyctenules begin along the limbal region and frequently degenerate to corneal ulceration and neovascularization.
How We Manage?
The first line of treatment for PKC is to decrease the inflammatory response.
PKC is generally responsive to topical steroids. So we put them under Fluorometholone (FML)
In cases with corneal ulceration or pretreatment, It’s always better to use of antibiotics along with corticosteroids. I personally prefer gatifloxacin.
In cases with multiple recurrences, or those which become steroid dependent, topical cyclosporine A is an effective treatment option.