Abstract
BackgroundPhlyctenular keratitis is a hypersensitivity reaction of the cornea, and a complication of eyelid margin disease in children and young adults. In this study, we compared the morphology of the meibomian glands in eyelids between phlyctenular keratitis patients and healthy young adults, using noncontact meibography.MethodsThe study included 16 eyes of 13 patients diagnosed with phlyctenular keratitis and 17 eyes of 17 healthy volunteers. Slit-lamp observations of the cornea and eyelid were performed on all subjects. The morphology of the meibomian glands was scored using non-contact meibography (meiboscore). The meiboscore in worse eye was used in bilateral phlyctenular keratitis.ResultsAll eyes with phlyctenular keratitis, but not normal controls, showed corneal nodules, neovascularization, and superficial punctate keratopathy. The mean meiboscore in phlyctenular keratitis patients (upper lid: 2.9 ± 0.3, lower lid: 2.7 ± 0.5) was significantly higher than in controls (upper lid: 0.4 ± 0.6, lower lid: 0.1 ± 0.3).ConclusionsNoncontact meibography enabled visualization of meibomian gland loss in phlyctenular keratitis patients, suggesting a relationship between abnormalities of the meibomian glands in young individuals and the pathogenesis of phlyctenular keratitis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12886-016-0347-5) contains supplementary material, which is available to authorized users.
Highlights
Phlyctenular keratitis is a hypersensitivity reaction of the cornea, and a complication of eyelid margin disease in children and young adults
Phlyctenular keratitis is a complication of eyelid margin disease, primarily affecting children and young adults [1, 2]
The characteristic clinical findings in phlyctenular keratitis include inflammatory corneal nodules with vascularization and meibomitis [3]. The pathogenesis of this disease could involve a delayed-type hypersensitivity (DTH) reaction to foreign microbial proteins from organisms such as Mycobacterium tuberculosis, Staphylococcus aureus, or Propionibacterium acnes, which are found at the eyelid margin and in the meibomian gland [3,4,5,6,7,8,9,10]
Summary
Phlyctenular keratitis is a hypersensitivity reaction of the cornea, and a complication of eyelid margin disease in children and young adults. The characteristic clinical findings in phlyctenular keratitis include inflammatory corneal nodules with vascularization and meibomitis [3]. The pathogenesis of this disease could involve a delayed-type hypersensitivity (DTH) reaction to foreign microbial proteins from organisms such as Mycobacterium tuberculosis, Staphylococcus aureus, or Propionibacterium acnes, which are found at the eyelid margin and in the meibomian gland [3,4,5,6,7,8,9,10]. It is often difficult to observe the condition of the eyelid or of the meibomian glands in children who cannot be secured to a chin-rest.
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