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Thygeson Superficial Punctate Keratitis Workup

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

Laboratory Studies

Culturing the flora of the cornea during active inflammation may be helpful in future research, but it is not necessary for the diagnosis, treatment, or management of the disease.


Imaging Studies

Slit lamp photography may be used to document active inflammation and periods of inactivity, but it is not necessary to successfully diagnose or manage the disease.


Histologic Findings

Intracellular and intercellular edema at the epithelial level are common histological features of TSPK.[14, 15, 16]

Other abnormalities have been observed in the subepithelial nerve plexus, the Bowman membrane, and the anterior stroma. These changes are most severe in eyes with a longer duration of disease and can possibly be reversed with topical steroid therapy.[15]



TSPK is in either the active stage or the inactive stage of the disease.

As mentioned above, 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]

During the inactive stages of the disease, the lesions can disappear, or they can appear as flat gray, stellate shaped, subepithelial opacities that do not stain with fluorescein.[4, 7] Also, some patients develop subepithelial opacities that occasionally become permanent even in the absence of overlying epithelial disease.[3]

Attacks may last up to several months and go into remission for up to 3 years.[2, 7] The disease may continue for an average period of 3.5-7.5 years, although reports of more than 24, 30, and 41 years have been reported, particularly with steroid use.[2, 17]

Contributor Information and Disclosures

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.

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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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