Clinical Aspects of Phlyctenular Keratoconjunctivitis Using a Tear Film Interferometer

Dong Hyun Kang; Sang Wroul Song; Byung Yeop Kim; Kyu Yeon Hwang; Kook Young Kim

doi:10.3341/jkos.2020.61.1.1

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Kang, Song, Kim, Hwang, and Kim: Clinical Aspects of Phlyctenular Keratoconjunctivitis Using a Tear Film Interferometer

Original Article

Journal of the Korean Ophthalmological Society 2020; 61(1): 1-8.

Published online: 15 January 2020

DOI: https://doi.org/10.3341/jkos.2020.61.1.1

Clinical Aspects of Phlyctenular Keratoconjunctivitis Using a Tear Film Interferometer

Dong Hyun Kang, MD, Sang Wroul Song, MD, Byung Yeop Kim, MD, Kyu Yeon Hwang, MD, Kook Young Kim, MD

Myung-Gok Eye Research Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea.

Address reprint requests to Kook Young Kim, MD. Kim's Eye Hospital, #136 Yeongsin-ro, Yeongdeungpo-gu, Seoul 07301, Korea. Tel: 82-2-1577-2639, Fax: 82-2-2671-6359, m_d@daum.net

Received 19 July 2019 Revised 16 August 2019 Accepted 30 December 2019

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate clinical findings in phlyctenular keratoconjunctivitis patients and assess the function and morphology of Meibomian glands using an interferometer (LipiView®, TearScience, Morrisville, NC, USA) in such patients.

Methods

This retrospective study included 19 eyes of 13 patients diagnosed with phlyctenular keratoconjunctivitis. The lipid layer thickness (LLT) and meibograph of each eye was quantified by tear interferometry. Tear film break-up time (TBUT) and corneal staining score were measured. Meibomian gland morphology (lid margin vascularity, plugging of gland orifices, lid margin irregularity, lid margin thickening, and partial glands) was evaluated based on anterior photographs and meibographs.

Results

The mean age was 21.3 years (8–44 years). Mean BUT and Oxford corneal staining scores were 2.6 ± 1.2 seconds and 1.9 ± 0.8, respectively. Abnormal findings of the Meibomian glands were observed in all patients. The mean LLT was 79.6 ± 27.4 µm and the incomplete eye blinking frequency was 3.8 ± 5.9 during 20 seconds. The graphs of the tear lipid layer showed various patterns such as flat, up-hill, down-hill, and mixed.

Conclusions

Meibomian gland dysfunctions and changes in the tear film lipid layer were noted in patients with phlyctenular keratoconjunctivitis. These factors are to be considered for the treatment of phlyctenular keratoconjunctivitis in young patients under 10 years of age.

Keywords: Dry eye, Lipid layer thickness, Meibomian gland, Phlyctenular keratitis, Tear film stability

Figures and Tables

Figure 1

Examples of graphs which tear film lipid layer thickness measured by Lipiview® (TearScience Inc., Morrisville, NC, USA). Flat type in case 3, up-hill type in case 10, down-hill type in case 13, mix type in case 5.

Figure 2

Initial presentation of a 10-year-old female patient (case 3). Telangiectasia, plugging of Meibomian gland orifices, and lid debris can be seen (A, B). The ocular surface is shown, accompanied by superficial neovascularization, corneal infiltration, and mild hyperemia of the bulbar conjunctiva in both eyes (C, D). Fluorescein staining shows superficial punctate keratitis on both corneas, along with infiltration (E, F).

Figure 3

Images obtained by Lipiview® (TearScience Inc., Morrisville, NC, USA) interferometer in 8-year-old (case 1, A), 14-year-old (case 4, B), 10-year-old (case 3, C, D) and 25-year-old (case 10, E, F).Meibomian gland dilatation, partial gland and gland dropout were observed in younger patients.

Table 1

Grading scales for meibomian gland dysfunction

Table 2

Initial presentation of phlyctenular keratoconjunctivitis patients

BCVA = best corrected visual acuity; BUT = tear breakup time; LLT = lipid layer thickness; F = female; OD = right eye; OS = left eye.

Table 3

Lipiview parameters in phlyctenular keratoconjunctivitis patients

Values are presented as mean ± standard error deviation.

LLT = lipid layer thickness.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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