The phlycten, a come-back?

In February 1980 acute keratoconjunctivitis was seen in a girls' class in a school in Rotterdam. Bacteriological and virological examination was performed on 20 girls. The agent causing this epidemic could not be demonstrated. Three patients had phlyctens at the limbus. In the year following this observation (March 1980 till March 1981) 42 cases of phlyctenular keratoconjunctivitis were examined prospectively. The condition was most commonly seen in 13- to 18-year old girls. The phlycten can be considered as an elementary form of inflammation in the conjunctiva and cornea, based on an immune reaction of the delayed type (Gell and Coombs' type IV). The hypersensitivity to tuberculin, which was formerly an important feature of this inflammation ('scrofulous ophthalmia'), is of little importance in the Netherlands at the present day. However, in every case of phlyctenular keratoconjunctivitis tuberculosis should still be excluded by the medical history, and if necessary by a Mantoux reaction.