Thygeson’s Superficial Punctate Keratitis- Case Report and Review

Abstract

Thygeson's superficial punctate keratitis is a subtle, chronic and bilateral condition of the corneal epithelium, typically manifests with acute exacerbations and remissions. The etiology remains uncertain, despite the possibility of viral etiology was suspected. Topical steroid administration is useful in aborting an acute phase; but steroid induced cataract and glaucoma developed on long term usage. Topical cyclosporine A was used successfully for prolonged periods with minimal ocular surface irritation. The purpose of this case study was to highlight the importance of diagnosing the problem clinically and also to report efficacy and ocular side effects of topical cyclosporine A. Twenty six year old boy presented with persistent foreign body sensation in July 2011, since one month in both the eyes. Slit lamp microscopic examination revealed bilateral, multiple and punctate corneal epithelial lesions. The lesions resolved on topical steroids but recurred after cessation of the therapy. With the daily instillation of topical cyclosporine A, recurrence was not observed in two year follow up. Although topical steroid was useful in aborting an acute phase, the disease remitted on cessation of the therapy. Topical cyclosporine A, used for two years was effective in controlling the exacerbations without discernible ocular side effects. 1.2 Thygeson's superficial punctate keratitis is essentially an objective opinion with other investigations proven to be discouraging. The disease manifests bilaterally with irritation, photophobia, excessive watering, and foreign body sensation and on occasions, with visual disturbances in the acute phase. The purpose of presenting the present case report is to highlight the importance of diagnosing the disease clinically by excluding the other causes that produce punctate epithelial lesions. And also to find out the efficacy of cyclosporine A on long term usage and its complications. The clinical findings and management in this section were correlated and discussed with the currently available literature.