J Korean Ophthalmol Soc.  2011 Jan;52(1):7-13. 10.3341/jkos.2011.52.1.7.

Analysis of Clinical Characteristics in Phlyctenular Keratoconjunctivitis at a Tertiary Center

• Jo DH
• Kim MK
• Wee WR
• Lee JH

• KMID: 2214131
• DOI: http://doi.org/10.3341/jkos.2011.52.1.7

Abstract

PURPOSE
To report the clinical characteristics of patients with phlyctenular keratoconjunctivitis at a tertiary care center in Korea.
METHODS
The authors of the present study retrospectively reviewed the medical records of 26 patients who were diagnosed with phlyctenular keratoconjunctivitis, identifying the age and sex at diagnosis, diagnosis of the referring clinic, laterality and location of the lesions, the results of bacterial cultures from the meibum, and treatment options.
RESULTS
Eighteen patients (76.2%) were female, and the mean age at diagnosis was 18.4 +/- 10.5 years. Nine patients (34.6%) showed evidence of bilateral diseases, and corneal lesions were observed in 27 eyes of 21 patients. Bacterial cultures from the meibum were performed for 17 patients, with the following results: 6 cases of Staphylococcus epidermidis, 4 cases of Corynebacterium species, and 1 case of Propionibacterium acne. Neovascularization with corneal phlyctenules occurred from the inferior quadrant mostly. Twenty-four patients received the remission treatment of prednisolone acetate 1% eye drops and evidence of regression of new vessels was observed in all patients. Three patients (16.7%) experienced recurrence despite the maintenance treatment of cyclosporine 0.05% eye drops. Visual acuities improved significantly after the remission treatment, as compared to the initial visit.
CONCLUSIONS
The phlyctenular keratoconjunctivitis patients who visited the tertiary center in Korea showed similar findings regarding demographics, involvement of blepharitis, and identified microorganisms, as compared with patients in previous reports. However, corneal lesions involving the visual axis were frequent, suggesting that with proper diagnosis and treatment, improvement in visual acuities is possible.

Keyword

Blepharitis; Cornea; Keratoconjunctivitis; Korean; Phlyctenular keratitis

MeSH Terms

Acne Vulgaris
Blepharitis
Cornea
Corynebacterium
Cyclosporine
Demography
Eye
Female
Humans
Keratoconjunctivitis
Korea
Medical Records
Ophthalmic Solutions
Prednisolone
Propionibacterium
Recurrence
Retrospective Studies
Staphylococcus epidermidis
Tertiary Care Centers
Visual Acuity
Cyclosporine
Ophthalmic Solutions
Prednisolone

Figure

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  Figure 1. Diagram for definition of quadrant in analysis of involvement of phlyctenular keratitis.

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  Figure 2. Age distributions of phlyctenular keratoconjunctivitis patients: 5 patients under age 10, 13 patients between 11 and 20, 6 patients between 21 and 30, and 2 patients over age 31, 40 and 50, respectively.

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  Figure 3. Representative cases of phlyctenular conjunctivitis (A) and keratitis (B). A whitish elevated lesion with neovascularization from the conjunctiva across the limbus was a typical manifestation of phlyctenular keratitis (B).

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  Figure 4. Visual acuity of phlyctenular keratitis patients. Visual acuity improved significantly after remission treatment in patients whose visual axes were threatened (P=0.028). Black line: Patients whose visual axes were threatened, gray line: All keratitis patients; dashed line: Patients whose visual axes were spared, asterisk (*): statistically significant (P<0.05).

Reference

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