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Thygeson Superficial Punctate Keratitis Clinical Presentation

  • Author: Robert S Duszak, OD, FAAO; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Oct 13, 2014
 

History

Patients with TSPK often report bilateral tearing, burning, photophobia, foreign body sensation, and ocular irritation during exacerbations.

During the inactive stages of the disease, patients may have no complaints.

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Physical

TSPK is characterized by a bilateral, recurrent, focal, epithelial keratitis without associated conjunctival or stromal inflammation.[2, 3, 4, 5, 6] The classic corneal lesion in active TSPK is a conglomerate of coarse, oval shaped, slightly raised, whitish gray dots that stain minimally with fluorescein. The lesions tend to accumulate centrally in the cornea, and 1-50 lesions may be present (averaging about 20 lesions per flare-up).[7]

Corneal sensitivity is typically normal or only slightly decreased, but it is never completely absent as in herpes simplex keratitis.[2]

Although a conjunctival response is typically not seen, a minimal reaction by way of conjunctival injection may be noted.[3, 8]

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Causes

The exact etiology of TSPK is unclear.

Associations with various viral infections, including the adenovirus, herpes simplex virus, and varicella zoster virus, have been made.[9, 10] In 1953, Braley and Alexander provided questionable results suggesting a virus may be responsible for TSPK, and, in 1974, Lemp et al were able to isolate the varicella zoster virus from a corneal surface, albeit a 10-year-old boy.[9, 10] In more recent studies using polymerase chain reactions, the varicella zoster virus was not detected in eyes with TSPK, providing doubts this virus is the causative agent.[11, 12, 13]

HLA-DR3, an antigen associated with immune response genes and multiple autoimmune disorders, has some association with TSPK as well. It has been proposed that this antigen may alter the immune response of individuals with TSPK, yielding the prolonged course of the disease and its hallmark of exacerbations and remissions.[3]

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Contributor Information and Disclosures
Author

Robert S Duszak, OD, FAAO Attending Physician, Philadelphia Veterans Affairs Medical Center; Consulting Staff, Nemours Health Clinic, Mayfair Eye Associates; Adjunct Clinical Faculty, Eye Institute of the Pennsylvania College of Optometry

Robert S Duszak, OD, FAAO is a member of the following medical societies: American Geriatrics Society, American Academy of Optometry, American Optometric Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Hospital

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, International Society of Refractive Surgery, Cornea Society, Eye Bank Association of America

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cornea Society, Allergan, Bausch & Lomb, Bio-Tissue, Shire, TearScience, TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue, TearScience.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Richard W Allinson, MD Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center; Senior Staff Ophthalmologist, Scott and White Clinic

Richard W Allinson, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

References
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  2. Tabbara KF, Ostler HB, Dawson C, Oh J. Thygeson's superficial punctate keratitis. Ophthalmology. 1981 Jan. 88(1):75-7. [Medline].

  3. Darrell RW. Thygeson's superficial punctate keratitis: natural history and association with HLA DR3. Trans Am Ophthalmol Soc. 1981. 79:486-516. [Medline].

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  9. Lemp MA, Chambers RW Jr, Lundy J. Viral isolate in superficial punctate keratitis. Arch Ophthalmol. 1974 Jan. 91(1):8-10. [Medline].

  10. Braley AE, Alexander RC. Superficial punctate keratitis; isolation of a virus. AMA Arch Ophthalmol. 1953 Aug. 50(2):147-54. [Medline].

  11. Reinhard T, Roggendorf M, Fengler I, Sundmacher R. PCR for varicella zoster virus genome negative in corneal epithelial cells of patients with Thygeson's superficial punctate keratitis. Eye. 2004 Mar. 18(3):304-5. [Medline].

  12. Reinhard T, Sundmacher R. Topical cyclosporin A in Thygeson's superficial punctate keratitis. Graefes Arch Clin Exp Ophthalmol. 1999 Feb. 237(2):109-12. [Medline].

  13. Connell PP, O'Reilly J, Coughlan S, Collum LM, Power WJ. The role of common viral ocular pathogens in Thygeson's superficial punctate keratitis. Br J Ophthalmol. 2007 Aug. 91(8):1038-41. [Medline].

  14. Cheng LL, Young AL, Wong AK, Law RW, Lam DS. In vivo confocal microscopy of Thygeson's superficial punctate keratitis. Clin Experiment Ophthalmol. 2004 Jun. 32(3):325-7. [Medline].

  15. Watson SL, Hollingsworth J, Tullo AB. Confocal microscopy of Thygeson's superficial punctate keratopathy. Cornea. 2003 May. 22(4):294-9. [Medline].

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  19. Fintelmann RE, Vastine DW, Bloomer MM, Margolis TP. Thygeson Superficial Punctate Keratitis and Scarring. Cornea. 2012 Apr 10. [Medline].

  20. Gock G, Ong K, McClellan K. A classical case of Thygeson's superficial punctate keratitis. Aust N Z J Ophthalmol. 1995 Feb. 23(1):76-7. [Medline].

  21. Del Castillo JM, Del Castillo JB, Garcia-Sanchez J. Effect of topical cyclosporin A on Thygeson's superficial punctate keratitis. Doc Ophthalmol. 1996-1997. 93(3):193-8. [Medline].

  22. Hasanreisoglu M, Avisar R. Long-term topical cyclosporin A therapy in Thygeson's superficial punctate keratitis: a case report. Cases J. 2008 Dec 23. 1(1):415. [Medline].

  23. Forstot SL, Binder PS. Treatment of Thygeson's superficial punctate keratopathy with soft contact lenses. Am J Ophthalmol. 1979 Aug. 88(2):186-9. [Medline].

  24. Goldberg DB, Schanzlin DJ, Brown SI. Management of Thygeson's superficial punctate keratitis. Am J Ophthalmol. 1980 Jan. 89(1):22-4. [Medline].

  25. Jabbur NS, O'Brien TP. Recurrence of keratitis after excimer laser keratectomy. J Cataract Refract Surg. 2003 Jan. 29(1):198-201. [Medline].

  26. Seo KY, Lee JB, Jun RM, Kim EK. Recurrence of Thygeson's superficial punctate keratitis after photorefractive keratectomy. Cornea. 2002 Oct. 21(7):736-7; author reply 737. [Medline].

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  28. Fite SW, Chodosh J. Photorefractive keratectomy for myopia in the setting of Thygeson's superficial punctate keratitis. Cornea. 2001 May. 20(4):425-6. [Medline].

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The cornea of a 33-year-old African American man with active Thygeson superficial punctate keratitis (TSPK).
 
 
 
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