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The phlycten, a come-back?

H C Koppert, G van Rij

    Documenta Ophthalmologica. Advances in Ophthalmology
    |January 29, 1982
    PubMed
    Summary
    This summary is machine-generated.

    An outbreak of acute keratoconjunctivitis occurred in a school, but the causative agent remained unidentified. Subsequent examination of phlyctenular keratoconjunctivitis cases suggests a delayed-type immune response, with tuberculosis needing exclusion.

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    Area of Science:

    • Ophthalmology
    • Infectious Disease Epidemiology
    • Immunology

    Background:

    • Acute keratoconjunctivitis outbreak observed in a girls' school in Rotterdam in February 1980.
    • Initial bacteriological and virological examinations of 20 affected girls failed to identify the causative agent.
    • Phlyctens at the limbus were noted in three patients during the initial outbreak.

    Purpose of the Study:

    • To prospectively examine cases of phlyctenular keratoconjunctivitis following an initial outbreak.
    • To understand the immunological basis of phlyctenular keratoconjunctivitis.
    • To assess the relevance of tuberculosis in contemporary cases of phlyctenular keratoconjunctivitis.

    Main Methods:

    • Prospective examination of 42 cases of phlyctenular keratoconjunctivitis between March 1980 and March 1981.

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  • Clinical observation and patient history collection.
  • Consideration of delayed-type hypersensitivity (Gell and Coombs' type IV) as the underlying mechanism.

    • Main Results:

    • Phlyctenular keratoconjunctivitis was most frequently observed in adolescent girls aged 13–18 years.
    • The phlycten is characterized as a basic inflammatory form of the conjunctiva and cornea.
    • The study highlights that hypersensitivity to tuberculin, previously linked to 'scrofulous ophthalmia', has diminished significance in the Netherlands.

    Conclusions:

    • Phlyctenular keratoconjunctivitis is understood as a type IV hypersensitivity immune reaction.
    • While historically linked to tuberculosis, its current relevance is reduced.
    • Tuberculosis must still be excluded in all cases of phlyctenular keratoconjunctivitis through medical history and potentially a Mantoux test.