Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Thygeson Superficial Punctate Keratitis Treatment & Management

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

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.[18] 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, 19]

A few successful therapies for TSPK do exist.

Topical lubricants have been shown to be an effective treatment method for relieving clinical symptoms.[20]

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, 21, 22]

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.[21, 23] Contact lenses improve symptoms by covering the elevated corneal lesions and nerves, which are constantly in friction with the conjunctiva during blinking.[2, 24]

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.[17]

Next

Surgical Care

There are a few reports of remission and recurrence following laser refractive surgery.[25, 26, 27, 28]

Fite and Chodosh reported that the use of photorefractive keratectomy (PRK) prevented the recurrence of TSPK in the area of the excimer laser treatment.[28]

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).[26]

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, 26]

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

  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].

  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. 2004 Jan. 111(1):34-7. [Medline].

  6. Thygeson P. Clinical and laboratory observations on superficial punctate keratitis. Am J Ophthalmol. 1966 May. 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. 1982 Dec. 53(12):985-6. [Medline].

  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].

  16. Kobayashi A, Yokogawa H, Sugiyama K. In vivo laser confocal microscopy findings of Thygeson superficial punctate keratitis. Cornea. 2011 Jun. 30(6):675-80. [Medline].

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

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

  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].

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

  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].

 
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 © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.