SIGNS AND SYMPTOMS
Patients typically present with symptoms of tearing, ocular irritation, mild to severe photophobia and a history of similar episodes. If the underlying cause is Staphylococcal infection, expect to see a rope-like, mucopurulent discharge as well.
There are two distinct types of phlyctenular lesions: corneal and conjunctival. Under the slit lamp a conjunctival (vascularized) phlyctenule appears as a 1 to 3mm hard, triangular, slightly elevated, yellowish-white nodule surrounded by a hyperemic response, in the vicinity of the inferior limbus. These lesions tend to be bilateral.
Corneal phlyctenules produce more severe symptoms. They usually begin adjacent to the limbus as a white mound, with a radial pattern of vascularized conjunctival vessels. The lesion may then migrate toward the center of the cornea, progressing as a gray-white, superficial ulcer surrounded by infiltrate in the areas where the lesion has been.
If the suspected etiology is Staph. reaction or acne rosacea, prescribe 250mg of oral tetracycline QID or 250mg erythromycin QID PO, along with topical antibiotic ointments such as bacitracin or erythromycin at bedtime. Topical metronidazole (Metrogel) applied to the skin TID is also effective. Because tetracycline can damage and discolor the teeth of children, it is contraindicated in patients under age 10. In these cases, substitute doxycycline 100mg TID or erythromycin 250mg QID PO. Continue treatment for two to four weeks. In suspicious cases, order a chest X-ray and PPD to rule out tuberculosis.
Other reports in this section
Eyelids & Eyelashes | Conjunctiva & Sclera | Cornea
Uvea | Vitreous & Retina | Optic Nerve & Brain | Oculosystemic Disease
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