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    Jurnal - INF - Successful Treatment of Phlyctenular Keratoconjunctivitis With Topical - HV - 2018

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    Jurnal - INF - Successful Treatment of Phlyctenular Keratoconjunctivitis With Topical - HV - 2018

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    Herdy Veristian
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    Jurnal_INF_Successful treatment of phlyctenular keratoconjunctivitis with topical_HV_2018

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    Jurnal - INF - Successful Treatment of Phlyctenular Keratoconjunctivitis With Topical - HV - 2018

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    of 2

    Contact Lens & Anterior Eye 36 (2013) 265–266

    Contents lists available at ScienceDirect

    Contact Lens & Anterior Eye


    journal homepage: www.elsevier.com/locate/clae

    Case report

    Successful treatment of phlyctenular keratoconjunctivitis with topical


    cyclosporin A
    Olugbemisola Oworu, Pouya Alaghband ∗ , Colin Hutchinson
    Huddersfield Royal Infirmary, UK

    a r t i c l e i n f o

    Article history:
    Received 21 October 2012
    Received in revised form 16 February 2013
    Accepted 21 February 2013

    Dear Sir,

    We report a case of an 18 year-old female of Asian origin who


    presented with phlyctenular keratoconjunctivitis (PKC) in the left
    eye. This was resistant to conventional treatment but responded
    satisfactorily to topical cyclosporin A 0.2% (CSA).

    1. Case report

    An 18-year-old Asian female presented with a 4 year history


    of recurrent discomfort, redness and photophobia in the left eye.
    There was no preceding trauma and she had no significant past
    medical history. There was no clinical or radiological evidence of
    tuberculosis, sarcoidosis, Behçet’s disease and Rosacea. She has pre-
    viously been successfully treated for PKC in both eyes with steroid
    eye drops.
    She has bilateral posterior blepharitis and a limbal PKC in the left
    eye (Fig. 1). There was no corneal infiltrates, inflamed pingueculum,
    marginal corneal ulcer nor signs of herpetic keratitis. Visual acuity
    was 6/6 bilaterally. The corneal sensation was intact. No palpable Fig. 1. Conjunctival phlycten, a small pinkish elevated nodule situated in the midst
    preauricular node. On upper tarsus eversion examination she had of a hyperemic area at three o’clock position on the limbus. A leash of blood vessels
    mild papillary reaction. can be seen running from the phlycten in a triangular fashion.
    Initial treatment with lid hygiene, topical non-steroidal anti-
    inflammatory drugs showed no marked improvement. Treatment months after treatment was initiated and there was no recurrence
    with topical prednisolone acetate 1% four times daily with oral 2 year later (Fig. 2).
    erythromycin 250 mg bd for 4 months showed no effect either. The
    phlyctenular conjunctivitis endured in spite of this treatment. 2. Discussion
    She was then commenced on CSA ointment 0.2%
    (OPTIMMUNE® ) in the left eye and this led to a dramatic improve- Phlyctenular keratoconjunctivitis is a nodular inflammation of
    ment within 2 weeks. The limbal phlycten completely resolved 2 the perilimbal tissues that occurs secondary to an allergic hyper-
    sensitivity response of the cornea [1].
    It is presumed to be type IV cell-mediated hypersensitiv-
    ∗ Corresponding author at: Huddersfield Royal Infirmary, Lindley, Huddersfield ity to staphylococcal antigens and mycobacterium tuberculosis
    HD3 3EA, UK. Tel.: +44 1484347316. [2]. Other associations include worms [3] and parasites [4]. In a
    E-mail address: [email protected] (P. Alaghband). case series from Korea, they found Staphylococcus epidermidis and

    1367-0484/$ – see front matter © 2013 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
    http://dx.doi.org/10.1016/j.clae.2013.02.008
    266 O. Oworu et al. / Contact Lens & Anterior Eye 36 (2013) 265–266

    corneal infiltrate and neovascularisation. In few cases, the condition


    can become refractory to steroids [7].
    Topical CSA has been used in the treatment of severe
    steroid-dependent childhood PKC [8]. CSA inhibits calcineurin, sub-
    sequently down regulates IL-2 and T cell proliferation. This process
    reduces inflammation. In a case series of 11 children by Doan et al.
    the ocular tolerability of topical CSA 2% was excellent, blood levels
    remained consistently below the detectable limits. Despite the the-
    oretical increase in infection, they observed no local adverse events
    [8].
    This single case supports other studies (with more patients),
    both in treatment efficacy and safety, that CsA is effective and safe
    and may be an adjunct to more conservative or traditional treat-
    ments in refractory cases of PKC.
    No financial disclosure for authors to declare.

    References

    [1] Cullom RD, Chang B. Cornea: phylectenulosis. In: Cullom RD, Chang B, editors.
    The Wills eye manual: office and emergency room diagnosis and treatment of
    eye disease. Philadelphia, PA: J.B. Lippincott Co; 1994. p. 64–5.
    Fig. 2. Complete resolution of the limbal phlycten.
    [2] Abu el Asrar AM, Geboes K, Maudgal PC, et al. Immunocytological study of
    phlyctenular eye disease. Int Ophthalmol 1987;10:33–9.
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    1995;40:41–52.
    also noted that phlyctens were mostly located in the inferior quad- [4] Hussein AA, Nasr ME. The role of parasitic infections in the etiology of phlyctenu-
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