Phlyctenular conjunctivitis in African children.

Phlyctenular conjunctivitis is a focal inflammatory disease of the conjunctiva characterized by a rounded translucent nodule surrounded by a zone of hyperaemia. The nodule may be single or multiple and is situated on the conjunctiva, close to the corneal limbus. Histologically it is an aggregation of large numbers of lymphocytes and occasional polymorphonuclear cells. Secondary infection, photophobia, blepharospasm and lacrimation are features of this condition. Phlyctenular conjunctivitis is relatively rare among Europeans, but is still common in nonEuropean communities. In 1947 an American Medical Association investigation committee (Barnett, Fields, Milles, Silverstein and Bernstein, 1947) reported that 20% to 50% of children in Alaskan native villages had corneal scars, due to healed phlyctenulosis. Thygeson (1951) noticed a very high incidence of this condition among Apache Indians of Arizona during the years 1934 to 1938 and among the Negro and Puerto Rican children of New York City before World War II. At Baragwanath Hospital where we deal with an African urban community living under poor hygienic circumstances we see active phlyctenulosis among the children quite commonly. At the Children's Outpatient Department which is attended by children up to 9 years of age, and where the total yearly attendance of new cases is 40,000, 36 active cases of this condition were seen in a 12month period. We were particularly interested in elucidating the relationship of these cases to tuberculosis which is rife in the community.