J Korean Ophthalmol Soc.  2020 Jan;61(1):1-8. 10.3341/jkos.2020.61.1.1.

Clinical Aspects of Phlyctenular Keratoconjunctivitis Using a Tear Film Interferometer

• Kang DH
• Song SW
• Kim BY
• Hwang KY
• Kim KY

• KMID: 2468470
• DOI: http://doi.org/10.3341/jkos.2020.61.1.1

Abstract

PURPOSE
To evaluate clinical findings in phlyctenular keratoconjunctivitis patients and assess the function and morphology of Meibomian glands using an interferometer (LipiView®, TearScience, Morrisville, NC, USA) in such patients.
METHODS
This retrospective study included 19 eyes of 13 patients diagnosed with phlyctenular keratoconjunctivitis. The lipid layer thickness (LLT) and meibograph of each eye was quantified by tear interferometry. Tear film break-up time (TBUT) and corneal staining score were measured. Meibomian gland morphology (lid margin vascularity, plugging of gland orifices, lid margin irregularity, lid margin thickening, and partial glands) was evaluated based on anterior photographs and meibographs.
RESULTS
The mean age was 21.3 years (8-44 years). Mean BUT and Oxford corneal staining scores were 2.6 ± 1.2 seconds and 1.9 ± 0.8, respectively. Abnormal findings of the Meibomian glands were observed in all patients. The mean LLT was 79.6 ± 27.4 µm and the incomplete eye blinking frequency was 3.8 ± 5.9 during 20 seconds. The graphs of the tear lipid layer showed various patterns such as flat, up-hill, down-hill, and mixed.
CONCLUSIONS
Meibomian gland dysfunctions and changes in the tear film lipid layer were noted in patients with phlyctenular keratoconjunctivitis. These factors are to be considered for the treatment of phlyctenular keratoconjunctivitis in young patients under 10 years of age.

Keyword

Dry eye; Lipid layer thickness; Meibomian gland; Phlyctenular keratitis; Tear film stability

MeSH Terms

Blinking
Humans
Interferometry
Keratoconjunctivitis*
Meibomian Glands
Retrospective Studies
Tears*

Figure

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  Figure 1 Examples of graphs which tear film lipid layer thickness measured by Lipiview® (TearScience Inc., Morrisville, NC, USA). Flat type in case 3, up-hill type in case 10, down-hill type in case 13, mix type in case 5.

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  Figure 2 Initial presentation of a 10-year-old female patient (case 3). Telangiectasia, plugging of Meibomian gland orifices, and lid debris can be seen (A, B). The ocular surface is shown, accompanied by superficial neovascularization, corneal infiltration, and mild hyperemia of the bulbar conjunctiva in both eyes (C, D). Fluorescein staining shows superficial punctate keratitis on both corneas, along with infiltration (E, F).

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  Figure 3 Images obtained by Lipiview® (TearScience Inc., Morrisville, NC, USA) interferometer in 8-year-old (case 1, A), 14-year-old (case 4, B), 10-year-old (case 3, C, D) and 25-year-old (case 10, E, F).Meibomian gland dilatation, partial gland and gland dropout were observed in younger patients.

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