H16.25 Phlyctenular keratoconjunctivitis

Name of the Condition

• Phlyctenular Keratoconjunctivitis

Summary

Phlyctenular keratoconjunctivitis is an inflammatory condition affecting the cornea and conjunctiva, characterized by the formation of small, raised nodules (phlyctenules). It often results from hypersensitivity reactions, particularly to microbial antigens, and may cause redness, irritation, and vision changes. Prompt evaluation is important to identify the underlying trigger and prevent complications.

Causes

The condition is typically triggered by hypersensitivity to bacterial or viral antigens, most commonly Staphylococcus aureus. It may also arise from allergic reactions, tuberculosis exposure, or other infectious agents. In some cases, it can be associated with systemic conditions like atopy or vitamin A deficiency.

Risk Factors

• Chronic Staphylococcus colonization of the eyelids or conjunctiva.
• Atopic dermatitis or other allergic conditions.
• Exposure to tuberculosis or other infectious agents.
• Vitamin A deficiency or malnutrition.
• Poor eyelid hygiene or chronic blepharitis.

Symptoms

• Small, raised nodules on the conjunctiva or cornea.
• Redness and swelling of the eye.
• Itching, burning, or gritty sensation.
• Excessive tearing or discharge.
• Blurred vision or sensitivity to light.
• Feeling of a foreign body in the eye.

Diagnosis

Diagnosis involves a comprehensive eye exam, including slit-lamp microscopy to identify phlyctenules. Cultures or scrapings may be taken if infection is suspected. Additional tests, such as fluorescein staining, help evaluate corneal involvement. A thorough history of allergies, infections, or systemic conditions is also considered.

Treatment Options

Treatment focuses on addressing the underlying cause, such as antibiotic therapy for bacterial infections or antihistamines for allergies. Topical corticosteroids may reduce inflammation, while lubricating eye drops alleviate dryness. In severe cases, systemic medications or vitamin supplementation may be necessary.

Prognosis and Follow-Up

With appropriate treatment, most cases resolve without long-term complications. Follow-up is important to monitor for recurrence or progression, especially if underlying infections or deficiencies are present. Regular eye exams help ensure the condition does not lead to corneal scarring or vision loss.

Complications

• Corneal scarring or ulceration.
• Vision impairment if the cornea is involved.
• Chronic inflammation or recurrence.
• Secondary infections.

Lifestyle & Prevention

• Maintain good eyelid hygiene to reduce bacterial colonization.
• Avoid known allergens or irritants.
• Ensure adequate nutrition, including vitamin A.
• Use lubricating eye drops to keep the ocular surface moist.
• Seek prompt treatment for eyelid infections or blepharitis.

When to Seek Professional Help

Consult a healthcare provider if symptoms persist, worsen, or include severe pain, vision changes, or discharge. Immediate care is needed for signs of corneal involvement, such as persistent redness, sensitivity to light, or blurred vision.

Tips for Medical Coders

Document the presence of phlyctenules, associated symptoms, and any identified triggers (e.g., bacterial, allergic, or infectious causes) to support code assignment. Ensure clinical correlation with exam findings, as phlyctenular keratoconjunctivitis is distinguished by its characteristic nodular lesions.