Re-emphasizing Thygeson’s warning: conjunctival phlyctenulosis as presenting sign of impending clinical tuberculosis

Sharma, Kanika; Kalakoti, Piyush; Juneja, Rakesh; Sahu, Suman; Singh, Vartika; Subramanian, Prem S.

doi:10.1016/j.jcjo.2014.08.006

Cited by 5 publications

(3 citation statements)

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“…For example, in patients with underlying blepharokeratoconjunctivitis or MGD, eyelid margin/lash hygiene should be optimized using interventions such as warm compresses, eyelid massage, or eyelid cleaners (such as hypochlorous acid). 48 If active MTB (2,9,15) or helminthic infection 2,36,38 is identified, then eradication of these infections is of course essential from a standpoint of both systemic health and PKC. Similarly, identified vitamin A deficiency requires repletion, which should be coordinated with the patient's pediatrician.…”

Section: Discussionmentioning

confidence: 99%

“…The underlying pathophysiology of the disease is mediated by a type IV hypersensitivity reaction. 4–6 Classically, PKC was associated with systemic infection with Mycobacterium tuberculae (MTB) and/or malnourished states and was consequently historically referred to as “scrofulous keratitis.” 7 Although these historic etiologies for PKC may still be encountered frequently in developing countries, 2,8–13 they are now believed to be infrequent causes of PKC in developed countries 14,15 ; instead, adjacent external/eyelid disease is believed to now be the most frequent cause of modern PKC. 16 However, there are few large studies of PKC in developed countries to represent the current state of this disease.…”

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confidence: 99%

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Pediatric Phlyctenular Keratoconjunctivitis at a Tertiary Care Center in the United States

Kaufman

Chhadva

Bontu

et al. 2022

Cornea

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Purpose:The aim of this study was to evaluate characteristics and outcomes of pediatric phlyctenulosis at a tertiary care center in the United States.Methods:A retrospective cohort study of phlyctenulosis diagnosis in patients younger than 18 years was conducted. Demographics, presenting features, treatment regimens, and outcomes were analyzed.Results:Seventy patients (95 eyes) with phlyctenulosis were identified. Fifty-four patients (77.1%) were Hispanic, which was greater than the center's proportion of pediatric patients identifying as Hispanic (53.8%, P < 0.0001). Common comorbidities included adjacent external/lid disease (82.9%), allergic/atopic disease (18.6%), and viral infections (8.6%). Nine patients had tuberculosis testing which was negative in all cases. Five patients had vitamin A testing which revealed deficiency in 1 patient. Treatment regimens were diverse and included varying combinations of topical and systemic medications. Complications included corneal scarring (27.4%), corneal neovascularization (40.0%), amblyopia (16.8%), corneal perforation (3.2%), and severe limbal stem-cell deficiency (1.1%). 26.3% of affected eyes had final visual acuity worse than 20/40. Differences in rates of corneal complications between Hispanic and non-Hispanic patients were not statistically significant, although severe corneal complications including perforation occurred only in the Hispanic group.Conclusions:This study presents a modern cohort of phlyctenulosis at a tertiary center in the United States and includes a larger proportion of Hispanic patients than expected. Phlyctenulosis carries high corneal morbidity and may frequently result in reduced visual acuity. Similar rates of corneal complications were seen in Hispanic versus non-Hispanic patients, but severe corneal complications were seen only in the Hispanic group.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Pediatric Phlyctenular Keratoconjunctivitis at a Tertiary Care Center in the United States

Kaufman

Chhadva

Bontu

et al. 2022

Cornea

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“…All grafts were clear and stable with no suture-related complications. Few of the related studies and cases were reviewed [17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Postoperative Outcomes of Pterygium Excision Surgery with Autograft Using Autologous Blood Versus Conventional Sutures

Patel

Shah

Prajapati

et al. 2021

JPRI

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Introduction: Pterygium is an extremely common ocular condition believed to be occurring due to proliferation and overgrowth of abnormal epithelial and fibrovascular tissue onto the cornea. They are characterized by cellular proliferation, neovascularization, and inflammation. Ultraviolet rays (UVR) induced elastoid degeneration of subepithelial connective tissue, genetic alteration associated altered cytokine expression plays an important role in the pathogenesis of pterygium. The recent treatment entities include conjunctival autograft with good results. The most commonly used means of fixating conjunctival autografts is by sutures or fibrin glue. Aim: This study aimed at comparative assessment of postoperative outcomes of pterygium excision surgery with autograft using autologous blood versus conventional sutures. Methods: Forty post-operative cases of pterygium excision surgery with conjunctival autograft were enrolled in the study and serially followed up. The study included two groups of 20 patients each. Group-A included cases of pterygium excision with autograft using autologous blood, and Group-B included cases of pterygium excision with autograft and sutures. Post-operatively, patients were examined on the 1st, 7th and 30th day to document the graft loss. Graft stability was also assessed on day 1 in both groups. Final comparisons were documented in terms of graft edema, stability and recurrence. Also suture related complications like foreign body sensation, watering, discomfort, granuloma formation and suture abscess were assessed in follow-up. Results: Group-B (suture group) revealed better graft stability whereas displacement of graft was documented in six cases of Group-A. Graft edema was reported in 10 cases from Group A and 7 cases from Group B. On the 30th day, all patients of both groups presented with similar findings. However, subjective discomfort was reported to be more in group-B as compared to group-A during each follow-up. Conclusion: Issue of graft displacement was a critical challenge with autologous blood group (Group A) patients compared to suture-related complications in group B. Looking towards the evidence of less remarkable complications and almost similar outcomes, the surgeons dilemma on pterygium management still persists.

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Infectious Causes

Hofling-Lima¹,

Müller²

2017

Essentials in Ophthalmology

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Re-emphasizing Thygeson’s warning: conjunctival phlyctenulosis as presenting sign of impending clinical tuberculosis

Cited by 5 publications

References 5 publications

Pediatric Phlyctenular Keratoconjunctivitis at a Tertiary Care Center in the United States

Pediatric Phlyctenular Keratoconjunctivitis at a Tertiary Care Center in the United States

Postoperative Outcomes of Pterygium Excision Surgery with Autograft Using Autologous Blood Versus Conventional Sutures

Infectious Causes

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