Phlyctenular keratoconjunctivitis a potentially blinding disorder

Phlyctenular keratoconjunctivitis, a delayed hypersensitivity reaction to foreign proteins (i.e., bacterial products), occurs more often in children and young adults sensitized to Staphylococcus aureus inhabiting the lid margins. Clinical manifestations occur on the conjunctiva and/or the cornea. Management strategies used to treat a 14-year-old girl with a long history of keratoconjunctivitis with severe corneal involvement and secondary lacrimal gland enlargement included a complete ocular examination, blood workups, cultures, vigorous lid hygiene, topical antibiotics and steroids, and systemic doxycycline. Phlyctenular keratoconjunctivitis was diagnosed, and Streptoccocus viridans was found colonizing the lid margins and fornices. Subsequent treatment quieted the active inflammation and the secondary lacrimal gland enlargement. However, the residual corneal scarring permanently compromised visual acuity. This patient demonstrates the potentially blinding consequences of untreated phlyctenular keratoconjunctivitis. Moreover, Streptoccocus viridans is not frequently associated with this disorder. To our knowledge hypertrophy of the lacrimal gland, as a secondary complication of this disorder, has not been reported previously.