Dr Ben Wild
Overview |
The eyelids are made up of various types of skin, muscle, glands, hair follicles and much more. Their purpose is to protect the eyes from dryness, bright lights and irritants. As with skin everywhere on the body, the eyelid skin harbors bacteria. If the wrong type of bacteria colonize the eyelids or if there is an overgrowth of the normal bacteria, the eyelids can cause harm to the eyes. This harm can involve the cornea, the clear outermost layer of the eye in front of the colored iris, and the conjunctiva, the clear layer over the white part of the eye otherwise know as the sclera.
Frontal view of a healthy eye.
Phlyctenulosis refers to a hypersensitivity reaction usually within the conjunctiva but sometimes on the edge of the cornea to the bacteria on the eyelids. It is seen as an off-white nodule. If not treated, it can lead to perforation of the eye but usually only lasts 2-3 weeks. If it become chronic or recurrent, it may be associated with a tuberculosis infection.
Frontal view of a an eye with a yellow phlyctenule.
Signs and Symptoms |
Signs
Off white nodule on the conjunctiva or on the edge of the cornea with redness around the affected area.
Symptoms
Mild to moderate discomfort, redness, tearing.
Causes and Risk Factors |
Causes
Allergic hypersensitivity reaction to toxins created by the bacteria on the eyelids.
Risk factors
Blepharitis, rosacea, eczema, TB infection.
Prevention and Treatment |
Prevention
Daily eyelid hygiene.
Treatments
· Antibiotic eye drops and ointment.
· Steroid eye drops.
· Oral tetracycline pills.
· TB skin test if unresponsive to treatment.
Prognosis |
Most cases of phlyctenulosis are very easily managed through the aforementioned treatments. Without treatment, a phlyctenule can resolve on its own but are much more likely to cause permanent scarring, ulceration, blood vessel growth into the cornea and in very rare instances, perforation of the eye, which may lead to losing the eye. The causes of these conditions can usually be managed with proper lid hygiene but in some cases, need continuous treatment.