Phlyctenular keratoconjunctivitis in a patient with Staphylococcal blepharitis and ocular rosacea.
BACKGROUND
Phlyctenular keratoconjunctivitis is a type IV hypersensitivity reaction to an inciting agent. The presentation is usually bilateral. The diagnosis can be difficult, especially if compounded by an underlying skin disorder such as rosacea. The 2 types of phlyctenules are differentiated based on the location on the eye, i.e., conjunctival or corneal.


METHODS
A 22-year-old man presented with painful, bilateral, elevated vascularized corneal lesions. Ultimately, the diagnosis was bilateral phlyctenular keratoconjunctivitis secondary to concurrent posterior blepharitis and recurrent ocular rosacea. The patient was treated with topical steroids and followed up with until his lids and corneas stabilized. He was then maintained with oral doxycycline and cyclosporine ophthalmic emulsion 0.5%. Lid hygiene and maintenance is a key factor in the course of the disease.


CONCLUSIONS
Phlyctenular keratoconjunctivitis usually responds well to topical steroids, but any inciting agents should be identified and treated. Complications include corneal scarring, thinning, and perforation. Staphylococcus aureus is a common culprit, and tuberculosis as a possible cause should also be considered.
Neiberg
Maryke N
MN
Nova Southeastern University College of Optometry, Fort Lauderdale, Florida 33328, USA. Neiberg@niva.edu
Sowka
Joseph
J
D000284:Administration, Oral; D000287:Administration, Topical; D000328:Adult; D001372:Aza Compounds / Q000627:therapeutic use; D001762:Blepharitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D016572:Cyclosporine / Q000627:therapeutic use; D004318:Doxycycline / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D024841:Fluoroquinolones; D006801:Humans; D007637:Keratoconjunctivitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D000077266:Moxifloxacin; D009883:Ophthalmic Solutions / Q000627:therapeutic use; D011239:Prednisolone / Q000031:analogs & derivatives / Q000627:therapeutic use; D011804:Quinolines / Q000627:therapeutic use; D012393:Rosacea / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D013203:Staphylococcal Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy
D001372:Aza Compounds; D024841:Fluoroquinolones; D009883:Ophthalmic Solutions; D011804:Quinolines; D016572:Cyclosporine; C009935:prednisolone acetate; D011239:Prednisolone; D004318:Doxycycline; D000077266:Moxifloxacin