Daily Bolus of LR: Phlyctenulosis

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November 9, 2011 by dailybolusoflr



I recently had a young woman who came in complaining of bilateral irritated red eyes.  On examination she had small whitish nodules at the limbus in both eyes.   The ophthalmology consult evaluated the patient and provided me with a diagnosis I had not only never heard of but also couldn’t spell!


·         Phlyctenules are typically small 1-2mm nodules that are elevated and typically yellow or white in color

·         The most common location to find them is at the limbus, but they can be found on the bulbar conjunctiva or cornea

·         The phlyctenule is usually surrounded by an inflammatory response which appears hypervascular in nature

·         Phlyctenules can ulcerate and often disappear in 1-2 weeks

·         When they are on the conjunctiva they rarely scar, however when in the limbus or cornea they often can scar

·         Women are more affected than men

·         The most common cause in the US is staphylococcus but in other countries

·         Treatment involves good lid hygiene and discarding any contacts and ensuring the patient does not wear any contacts until the phlyctenules are gone

·         Drops given should include topical steroids, which will relieve the signs and symptoms, as well as an antibiotic drops such as tobramycin or moxifloxacin


Ref: Onofrey, Skorin and Holdeman. 2005. Ocular therapeutics handbook: a clinical manual (2nd edition)



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