Phlyctenular Conjunctivitis

[hazelrosedigal]

Help! My left eye has been red for two weeks now. I visited the doctor yesterday and was diagnosed with Phlyctenular Conjunctivitis. What worries me is that she recommended I get a biopsy if it still persists after the treatment. She gave me eye drops to relieve the symptoms. This is the first time I experienced this. Any insights, please? Thank you!

[John C Hagan III, MD, FACS, FAAO]

First of all the 'doctor' should be a Eye MD ophthalmologist. Likely you are on steroid eyedrops.  The need for a biopsy would depend on what it looks like and I can't tell that. Do a internet search and read more about it. Generally an Eye MD ophthalmologist does not need a biopsy to determine the diagnosis.

[hazelrosedigal]

Hi, thanks for your reply. I hope you can still take a look. Here's what it looks like: https://drive.google.com/file/d/14v-BtU08LoRhWQXpYQdcFzkYDfLbYIIY/view?usp=sharing. It has this small yellowish part in the conjunctiva that I believe is the phlycten. The doctor I visited was an opthalmologist. Do you think I should get a second opinion?

[hazelrosedigal]

here's a clearer photo https://drive.google.com/file/d/15-BI7L9I_xeNT83eNew1sUYjY6NlpNHt/view?usp=drivesdk

[John C Hagan III, MD, FACS, FAAO]

I don't see anything in those photos that looks like needs biopsy. Also not sure it is phlyectenular conjunctivits. Looks like it could be a much more common pinguecula  of the cornea, usually due to heavy sun exposure.  https://www.umkelloggeye.org/conditions-treatments/pinguecula#:~:text=A%20pinguecula%20is%20an%20alteration,actually%20grow%20onto%20the%20cornea.   Look at some internet search engine photos.  Usually responds to a short course of topical steroid drops and recommendations to protect the eye from heavy sun exposure with hat and uV blocking glasses. Can also be due to wearing contact lens.

[hazelrosedigal]

Hi, thank you for these very helpful insights. Right now, I have two eye drops. One is Sodium Hyaluronate and the other one is antibacterial/corticosteroid. The redness in my eyes is slowly fading but the bump is still here, please see photo: https://drive.google.com/file/d/15PT1ZE1KF_aQ-CHOqoNNMwSrefG4VDqU/view?usp=drivesdk. May I know how many days it normally disappear? Thank you so much!

[John C Hagan III, MD, FACS, FAAO]

Look on the other eye and see if you have a yellow spot, not as big or red but a yellow spot. If so that is sun damage and your treated eye will likely look like the other one when healed. If not it usually takes the steroid drops about 7-10 days to take the red out and flatten the lesion but everyone heals at a different rate.

[John C Hagan III, MD, FACS, FAAO]

Look onl your other eye and see if you have a yellow spot in the same place, if so this is sun damage and while the redness may go away the small yellow material will likely remain. If you don't the steroids usually have maximum effect at 10-14 days. After that usually that is as good as it gets.

[hazelrosedigal]

Hi! Thank you so much for your help. I'm now on my 4th day of applying a steroid eye drop, the red part has slowly decreased but the yellow with a little red lesion is still here. I have a follow-up check-up in 2 days. The doctor said I need to have a biopsy if it's persistent to see if it's cancerous or not. I'd probably get a second opinion by another opthalmologist by then. This has scared me for days and I hope it all turned out fine. Thank you!

[John C Hagan III, MD, FACS, FAAO]

Good luck, change of being a cancer extremely low

[hazelrosedigal]

I believe you. I live in the Philippines and it can be very hot here. Thank you so much!

[John C Hagan III, MD, FACS, FAAO]

good luck. very high likelihood the yellow spot is sun damage (pingueculum)  

[hazelrosedigal]

Hi! I visited another opthalmologist yesterday and you have the same diagnosis. He said it's caused by wind, dust and because my eyes are always dry. He gave me eye drops to help with it. Thank you so much for your help! I'm relieved.

[John C Hagan III, MD, FACS, FAAO]

Avoid heavy sun exposure, wear hat and UV blocking sunglasses, find the best artificial tears your eyes like and use them first thing in morning and several times /day.  Close to equator people live the more common these are.  Glad to help you.

[hazelrosedigal]

Hi! I'm here again. Just an update, after more than 2 mos of eyedrops, the ping in my eyes is completely gone now but I can still see visible veins. The part with ping before has turned a little brown to yellow and there are still visible red veins near it. I work from home so I work on computer a lot. Is this normal? I will attach a photo here. Thank you!

[hazelrosedigal]

Here's the photo:

https://drive.google.com/file/d/1PGd-W8iR1ihP-SOujwTNXpuRIHlxh5Rw/view?usp=drivesdk

[John C Hagan III, MD, FACS, FAAO]

Your eye looks great.  All eyes have veins on the surface (in the outer layer called the conjuntiva)  some more, some less.  These veins often dilate due to wind, pollen, smoke, dryness and other irritants. That is why there are so many drops at the drug store for 'red eyes'.    Your eye looks a lot better than earlier photos.  the conjunctiva contains elastic fibers which on prolonged sun exposure turn yellow and elevated.  they typically occure at 3 and 9 oclock and not 12 and 6 where the lid covers them.    I would just move on. Use artificial tears several times/day and avoid long sun exposure. The computer drys the eye so every 15 minutes on the computer look away from the screen across the room and blink 5-6 times. Us artifical tears every couple of hours.

[hazelrosedigal]

Thank you for answering, I was really worried about it. I'll follow your advice. Do you have any recommendations for a good brand of artificial tear in the market?

God bless you and your family!

[hazelrosedigal]

Thank you for answering, I was really worried about it. I'll follow your advice. Do you have any recommendations for a good brand of artificial tear in the market?

God bless you and your family!

[John C Hagan III, MD, FACS, FAAO]

There is no "best' artificial tears just like there is no "best' food.  There are many brands for 2 reasons:   1 It is a common problem  2 the same drop does not work for everyone.  start a list and give the tear a grade. If it stings or burns give F and don't buy again. If feels good but only for an hour give D   Ideal tear makes the eye feel good and lasts at least 4 hours. M y wife and I both havae dry eyes. I use "BLINK" she uses "SYSTANE"  other REFRESH   SOOTHE