Letters to the Editor
To the Editors:
A 4-year-old girl presented to us with redness of eyes for 15 days. During the past 3 months, she had had recurrent fever and cough every 15 days lasting for 2–3 days and relieved by symptomatic treatment. Antibiotic eye drops did not provide relief. The mother had abdominal tuberculosis, which was diagnosed 2 years earlier for which she took antituberculous therapy for 9 months. The child was not screened for tuberculosis at that time.
She was a well-grown child. Eyes had multiple pinkish white nodules with marked circumcorneal congestion (Fig. 1). Visual acuity was normal.
Her erythrocytic sedimentation rate was 36 mm at end of 1 hour. The Mantoux test result was positive (22 mm read after 48 hours), and sputum test result for acid-fast bacilli was negative. Chest radiograph revealed perihilar shadows. Chest radiograph of the grandmother was suggestive of active tuberculosis, but those of other family members were normal.
The diagnosis of phlyctenular conjunctivitis with occult tuberculosis was made and short course antitubercular therapy started with rifampin (10 mg/kg/d), isoniazid (10 mg/kg/d), ethambutol (20 mg/kg/d) and pyrazinamide (25 mg/kg/d) for initial 2 months followed by rifampin and isoniazide for the next 4 months. No medication was prescribed for the eye. Complete resolution of the ocular lesions was observed after 3 weeks of antituberculous therapy.
Phlycten is derived from the Greek word, phlyctaena, which means blister. The name is a misnomer because the lesion is actually a solid nodule that can be single or multiple. Histologically, it is an aggregation of lymphocytes and occasional polymorphonuclear cells. Conjunctival phlyctens are usually transient and asymptomatic, but occasionally, larger phlyctens cause frank pustular conjunctivitis with subsequent penetration into deeper structures, leading to permanent scar formation.1 Corneal phlyctens present with lacrimation, blepharospasm and photophobia and usually leave opacities, leading to permanent vision impairment.2
Tubercular phlyctenular conjunctivitis usually regresses completely with antitubercular therapy.
Keya Lahiri, MD, DCH
Amruta Landge, MD
Pallavi Gahlowt, MD, DCH, FCPS
Anand Bhattar, MD
Rajesh Rai, MD
Department of Pediatrics
D Y Patil Hospital and Research Centre
1. Duke ESDuke Elder S. Conjunctival diseases. In: System of Ophthalmology. 19651st ed London Henry Kempton:461–75 [Reprint 1977]
2. Ostler HB. Corneal perforation in nontuberculous (staphylococcal) phlyctenular keratoconjunctivitis. Am J Ophthalmol. 1975;79:446–448