Treatment of Phlyctenular Keratoconjunctivitis with Oral Tetracycline in Recurrent Phlyctenulosis

ABSTRACT

PURPOSE: We succesfully treated two patients for phlyctenular keratoconjunctivitis which had recurrent episode or was not respond to steroid therapy, with oral tetracycline. METHODS: A 20-year-old girl (Case 1) was referred here because of a two-year history of recurrnet episode of phlyctenular keratoconjunctivitis. There was small pinkish nodule, about 2mm in diameter, and adjacent conjunctival injection in the temporal limbus in her left eye. Corneal opacity and superficial corneal vascularization was located inferiorly. A 12-years-old girl (Case 2) had been followed for 1 years with a recurrent vascularized corneal lesion and infiltration in the right eye. Cultures of the conjunctiva and eyelids were obtained. RESULTS: In case 1, topical steroid treatment led to some improvement but it was only temporarily. She was treated with oral tetracycline at an initial dose of 250mg three times daily for 3 weeks followed by 250mg once daily for 3 weeks. In case 2, doxycycline 100mg twice daily for 2 weeks and tapered 10mg once daily for 3 weeks. All patients experienced rapid relief of symptoms and long term remission of their disease after oral tetracycline or doxycycline treatment. CONCLUSIONS: Oral tetracycline treatment is safe and effective treatment for resistant and recurrent phlyctenular keratoconjunctivitis. In children younger than 10 years of age, doxycycline shluld be recommended alternatively because tetracycline can discolor the teeth.