Thygeson Superficial Punctate Keratitis Treatment & Management

  • Author: Robert S Duszak, OD, FAAO; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Apr 14, 2010
 

Medical Care

Many therapies for TSPK have been tried and proven unsuccessful over the years.

Antibiotics have been shown to be an ineffective treatment method.[2]

Antivirals have had mixed results; mild improvements have been reported with trifluridine, but it has also been reported to cause the disease to disappear more slowly than when treated with corticosteroids alone.[17] In addition, there have been multiple observations that idoxuridine causes persistent subepithelial ghost opacities and scarring in individuals with TSPK; therefore, it is contraindicated.[2, 10]

A few successful therapies for TSPK do exist.

Topical lubricants have been shown to be an effective treatment method for relieving clinical symptoms.[18]

Topical corticosteroids are now considered to be the mainstream treatment of TSPK, as they have been shown to be very successful in managing both clinical signs and symptoms; however, there is speculation that the natural course of the disease is prolonged secondary to the introduction of these medications.[2, 5] In addition, topical cyclosporine has been reported to be effective when used as a first-line treatment of patients with TSPK, with the advantage of fewer adverse effects compared with corticosteroids.[12, 19, 20]

Therapeutic soft contact lenses used on an extended-wear basis also offer an alternative treatment, especially for severe cases, although potential complications (eg, microbial keratitis) may exist.[19, 21] Contact lenses improve symptoms by covering the elevated corneal lesions and nerves, which are constantly in friction with the conjunctiva during blinking.[2, 22]

Nagra et al have had overwhelming success with topical corticosteroids, and they suggest an initial management of TSPK with fluorometholone 0.1% (FML 0.1%) or a similar low-dose steroid, followed by the use of stronger steroids, and then extended-wear contact lenses or topical cyclosporine in a stepwise approach.[5] They reinforce an important point that steroids must be tapered gradually over the course of months in many patients, with some patients requiring longer term, infrequent, but regular use (ie, weekly, biweekly). Since therapy is aimed at providing patients with comfort, clinicians should be aware that the minimum strength and dosage of topical anti-inflammatory medications necessary to control symptoms should be prescribed.[16]

Next

Surgical Care

There are a few reports of remission and recurrence following laser refractive surgery.[23, 24, 25, 26]

Fite and Chodosh reported that the use of photorefractive keratectomy (PRK) prevented the recurrence of TSPK in the area of the excimer laser treatment.[26]

Seo et al suggested that the recurrence rate of TSPK following refractive laser procedures is lower with PRK than with laser in situ keratomileusis (LASIK).[24]

Other reports have suggested that both PRK and laser subepithelial keratomileusis (LASEK) do not prevent the recurrence of TSPK, and even similar attempts of debridement of the corneal epithelium are insufficient at alleviating the course of inflammation in these patients.[2, 24]

Previous
Next

Consultations

A consultation with a cornea specialist or an anterior segment specialist may be warranted if the diagnosis and the management of a patient with TSPK are confounding or if a patient is not responding to treatment.

Previous
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Robert S Duszak, OD, FAAO  Attending, 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 Academy of Optometry, American Geriatrics Society, and American Optometric Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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, and Texas Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

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

Disclosure: Nothing to disclose.

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

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

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching; EyeGate Pharma Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

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, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Thygeson P. Superficial punctate keratitis. J Am Med Assoc. Dec 30 1950;144(18):1544-9. [Medline].

  2. Tabbara KF, Ostler HB, Dawson C, Oh J. Thygeson's superficial punctate keratitis. Ophthalmology. Jan 1981;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].

  4. Jones BR. Thygeson's Superficial Punctate Keratitis. Trans Ophthalmol Soc U K. 1963;83:245-53. [Medline].

  5. Nagra PK, Rapuano CJ, Cohen EJ, Laibson PR. Thygeson's superficial punctate keratitis: ten years' experience. Ophthalmology. Jan 2004;111(1):34-7. [Medline].

  6. Thygeson P. Clinical and laboratory observations on superficial punctate keratitis. Am J Ophthalmol. May 1966;61(5 Pt 2):1344-9. [Medline].

  7. Arffa RC. Grayson's Diseases of the Cornea. 4th ed. St. Louis: Mosby-Year Book; 1997.

  8. Tantum LA. Superficial punctate keratitis of Thygeson. J Am Optom Assoc. Dec 1982;53(12):985-6. [Medline].

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

  10. Braley AE, Alexander RC. Superficial punctate keratitis; isolation of a virus. AMA Arch Ophthalmol. Aug 1953;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. Mar 2004;18(3):304-5. [Medline].

  12. Reinhard T, Sundmacher R. Topical cyclosporin A in Thygeson's superficial punctate keratitis. Graefes Arch Clin Exp Ophthalmol. Feb 1999;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. Aug 2007;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. Jun 2004;32(3):325-7. [Medline].

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

  16. Tanzer DJ, Smith RE. Superficial punctate keratitis of thygeson: the longest course on record?. Cornea. Nov 1999;18(6):729-30. [Medline].

  17. Nesburn AB, Lowe GH 3rd, Lepoff NJ, Maguen E. Effect of topical trifluridine on Thygeson's superficial punctate keratitis. Ophthalmology. Oct 1984;91(10):1188-92. [Medline].

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

  19. 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].

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

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

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

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

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

  25. Netto MV, Chalita MR, Krueger RR. Thygeson's superficial punctate keratitis recurrence after laser in situ keratomileusis. Am J Ophthalmol. Sep 2004;138(3):507-8. [Medline].

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

 
Previous
Next
 
The cornea of a 33-year-old African American man with active Thygeson superficial punctate keratitis (TSPK).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.