Monday, May 14, 2012


It is an allergic reaction of the conjunctiva caused by endogenous bacterial toxins and characterized by bleb or nodule formation near the limbus.


Aetiology :
          > Tuberculo-protein
          > Toxins from staphylococcus or streptococcus
          > Toxins from intestinal parasites

Clinical Types : 
          > Phyctenular conjunctivitis
          > Phyctenular Kerato-conjunctivitis
          > Phyctenular Keratitis

Symptoms :
           > Redness with formation of bleb
          > Irritation and lacrimation
          > Pain and photophobia


 Signs :
           > One or more small, round and raised nodule at or near the limbus.
          > Localized bulbar congestion
          > No conjunctival discharge
          > Secondary infection

Complications :
          > Phlyctenular keratitis
          > Fascicular ulcer
          > Superficial phlyctenular pannus
          > Ring ulcer

Investigations :
           A. To detect tuberculosis
                          - Sputum for AFB
                          - Blood for TLC, DLC, ESR
                          - X-ray Chest
                          - Mantoux test
         B. ENT consultation to exclude chronic tonsilitis or adenitis
         C. Stool for OPC
         D. Conjunctival swab and corneal scraping

Treatment :
         > Corticosteroid eye drop
         > In case of secondary infection, first treat bacterial conjunctivitis by local antibiotic drops and then treat with local corticosteroid drops.
         > When cornea involved - atropin (1%) eye ointment
         > Improvement of the nutritional status
         > Treatment of causal factors eg.
                          - Treatment of tuberculosis
                          - Treatment of tonsillitis or adenitis
                          - Antihelmintics for intestinal parasites.

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