Phlyctenular eye disease: a reappraisal.

PURPOSE: Phlyctenular keratoconjunctivitis is a nonspecific allergic response in the cornea and/or conjunctiva to a variety of distinct conditions. Tuberculosis as an etiological association is being supplanted by staphylococcal infection and worm infestation in developed countries. Our aim was to determine the relative frequency of the various known etiological factors of phlyctenular keratoconjunctivitis, and the clinical profile of the disease as it exists today in India, a country where tuberculosis is still highly prevalent. CASES: This is a prospective study of 112 consecutive patients with phlyctenular eye disease seen over a 2-year period. OBSERVATIONS: In 86 patients (76.7%), phlyctenular eye disease was associated with tuberculosis. Worm infestation was found in 14 patients (12.4%), whereas 7 (6.2%) had staphylococcal blepharitis. Thirteen patients had evidence of multiple etiology, of which one causative factor was always tuberculosis. When tuberculosis was the only association, 37% patients had severe lesions, whereas only 11. 5% patients without tuberculosis had such lesions. When tuberculosis along with another etiological factor was present, the incidence of severe lesions increased to 84.6%. Recurrence on follow-up was seen in three patients who were already on multidrug therapy for tuberculosis, and two who had tubercular allergy.
CONCLUSIONS: Our study shows that tuberculosis is still a major cause of phlyctenular eye disease in India. Severe lesions are more common in patients with tuberculosis, especially when another etiological factor is associated. Recurrences are more common in patients with tuberculosis. Corneal lesions are less extensive than described in the literature and are no longer a significant cause of blindness.