Corneal Phlyctenules as a Complication of Untreated Demodex Blepharoconjunctivitis

Purpose: To highlight the importance of early detection of demodex infection in young patients to prevent serious complications that can lead to permanent vision impairment. Observations: We are reporting a case of a 13-year-old female who presented to the clinic with redness, photophobia, and itching in both eyes for 7 days. She had no significant past systemic history and was occasionally on Tobradex eye ointment and artificial eye drops. On examination, both eyelids showed marginal hyperemia, redness, and blepharitis; the right eye cornea was clear centrally with peripheral vascularization; the left eye cornea showed two triangular elevated corneal phlyctenules with surrounding neovascularization. Conclusions and Importance: There are no specific management guidelines for demodex associated keratoconjunctivitis. Management of persistent inflammation involves suppressing the inflammatory response and reducing the antigens involved in the inflammatory process. Warm compresses, topical antibiotic ointment, topical steroids, oral antibiotics, and more aggressive topical therapy are recommended. This case report highlights the importance of a thorough clinical examination, immediate identification, appropriate management, and regular follow-up care for Demodex-associated keratoconjunctivitis.