Monday, May 14, 2012

PHLYCTENULAR CONJUNCTIVITIS


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


PHLYCTENULAR CONJUNCTIVITIS,CONJUNCTIVITIS


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

PHLYCTENULAR CONJUNCTIVITIS,CONJUNCTIVITIS

 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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