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World J Virol. Mar 25, 2026; 15(1): 117124
Published online Mar 25, 2026. doi: 10.5501/wjv.v15.i1.117124
Published online Mar 25, 2026. doi: 10.5501/wjv.v15.i1.117124
Phlyctenular keratoconjunctivitis with viral triggers
Matteo Capobianco, Giuseppe Gagliano, Eye Clinic, Policlinico G. Rodolico, University of Catania, Catania 95121, Italy
Matteo Capobianco, Alessandro Avitabile, Giuseppe Gagliano, Simonetta Gaia Nicolosi, Faculty of Medicine, University of Catania, Catania 95123, Italy
Francesco Cappellani, Fabiana D’Esposito, Caterina Gagliano, Department of Medicine and Surgery, University of Enna “Kore”, Enna 94100, Italy
Francesco Cappellani, Caterina Gagliano, Mediterranean Foundation, “G.B. Morgagni”, Catania 95125, Italy
Federico Visalli, Department of Ophthalmology, University of Catania, Catania 95123, Italy
Marieme Khouyyi, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina 98121, Italy
Fabiana D’Esposito, Imperial College Ophthalmic Research Group Unit, Imperial College, London NW1 5QH, United Kingdom
Marco Zeppieri, Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
Marco Zeppieri, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste 34129, Italy
Co-corresponding authors: Caterina Gagliano and Marco Zeppieri.
Author contributions: Zeppieri M, Nicolosi SG, D’Esposito F, Gagliano G, and Capobianco M did the research and writing of the manuscript; Zeppieri M, Nicolosi SG, D’Esposito F, Cappellani F, Khouyyi M, Visalli F, Gagliano C, and Capobianco M assisted in the writing of the draft and final paper; Zeppieri D’Esposito F, Cappellani F, Khouyyi M, Gagliano C, and Capobianco M were responsible for the conception and design of the study; Zeppieri M, Nicolosi SG, Avitabile A, D’Esposito F, Cappellani F, D’Esposito F, Gagliano C, Gagliano G, and Capobianco M assisted in the writing and editing of the manuscript; Zeppieri M and Gagliano C have played important and indispensable roles in the manuscript preparation as the co-corresponding authors; all authors provided the final approval of the article.
Conflict-of-interest statement: All authors declare no conflict of interest.
Corresponding author: Marco Zeppieri, MD, PhD, Consultant, Department of Ophthalmology, University Hospital of Udine, p. le S. Maria della Misericordia 15, Udine 33100, Italy.
Received: December 1, 2025
Revised: December 30, 2025
Accepted: February 5, 2026
Published online: March 25, 2026
Processing time: 104 Days and 22.1 Hours
Revised: December 30, 2025
Accepted: February 5, 2026
Published online: March 25, 2026
Processing time: 104 Days and 22.1 Hours
Core Tip
Core Tip: Phlyctenular keratoconjunctivitis is a delayed-type hypersensitivity disorder that often affects children. Triggers vary by setting: Mycobacterial antigens in tuberculosis-endemic areas; staphylococcal lid disease and ocular rosacea elsewhere. A minority of cases have viral associations [herpes simplex virus (HSV), coronavirus disease, molluscum contagiosum, etc.] that mirror the same antigen-driven mechanism and should be managed by addressing the viral source-antivirals when HSV is plausible and excision/ablation for eyelid molluscum-alongside brief steroids, lid hygiene, targeted antibiotics, and topical cyclosporine to reduce recurrences and steroid burden.