Phlyctenular keratoconjunctivitis with viral triggers.

Area of Science:

• Ophthalmology
• Immunology
• Pediatrics

Background:

• Phlyctenular keratoconjunctivitis (PKC) is a pediatric ocular surface disease.
• It results from a delayed-type hypersensitivity reaction to microbial antigens.
• Triggers vary by geographic location and include tuberculosis, staphylococcal infections, rosacea, and viral infections like HSV, COVID-19, and molluscum contagiosum.

Purpose of the Study:

• To review the epidemiologic, clinical, and immunopathologic data on PKC.
• To identify the diverse causes of pediatric PKC.
• To update current management strategies for PKC.

Main Methods:

• Literature review of epidemiologic, clinical, and immunopathologic studies on PKC.
• Synthesis of data to identify antigen triggers and treatment approaches.
• Analysis of treatment outcomes for various management strategies.

Main Results:

• PKC is antigen-mediated, with diverse triggers including bacterial, mycobacterial, and viral pathogens.
• Corneal involvement can lead to severe visual impairment, including neovascularization, scarring, amblyopia, and perforation.
• Effective management involves addressing the antigen source, prompt anti-inflammatory treatment, and steroid-sparing agents for recurrent cases.

Conclusions:

• Treatment should focus on the specific antigen source (e.g., tuberculosis, blepharitis, viral infections).
• Promptly suppressing inflammation with topical corticosteroids is crucial.
• Steroid-sparing agents like topical cyclosporine are valuable for managing recurrent or steroid-dependent disease.
• A trigger-focused, steroid-sparing approach minimizes recurrences and vision-threatening complications.