Thygeson's Superficial Punctate Research Articles

Modern possibilities of pathogenetically oriented therapy for dry eye syndrome

In recent years, anti-inflammatory therapy has become a significant part of the complex approach to treatment of patients with dry eye syndrome (DES), with cyclosporine preparations becoming increasingly important in the structure of the therapy. Taking into account the immunosuppressive effect of cyclosporine A, which is realized through hindering the activation of T-lymphocytes in the tissues of the ocular surface, its topical application in DES has a pronounced pathogenetic focus. Numerous clinical studies have shown that instillations of cyclosporine into the conjunctival cavity contribute to an increase in total tear production, as well as recovery of the density of goblet cells in the conjunctiva of DES patients. The positive effect of cyclosporine A instillations has been convincingly demonstrated in the complex therapy of patients with vernal and atopic corneal conjunctivitis, Thygeson's superficial punctate keratitis, autoimmune keratitis, meibomian gland dysfunction, etc. However, one significant problem associated with cyclosporine A instillations is the irritating effect of the drug. That prompted the development of a drug that is safe and tolerable during instillations into the conjunctival cavity - preservative-free 0.1% cyclosporine A labelled Ikervis (Santen, Japan). The drug carrier is artificial tear Cationorm (Santen), which has an advantage of stabilizing the tear film and protecting the ocular surface from the irritating effect of cyclosporine. According to numerous clinical studies, Ikervis instillations can improve the effectiveness of complex therapy in patients with DES (especially secondary to Sjögren syndrome, Stevens-Johnson syndrome, graft-versus-host disease), with allergic diseases of the cornea and conjunctiva (spring, atopic corneal conjunctivitis), with corneal transplant disease, and other similar conditions. The high efficacy and safety of Ikervis constitute the reason to recommend it for wide clinical use.

Using pre-existing social networks to determine the burden of disease and real-life needs in rare diseases: the example of Thygeson's superficial punctate keratitis

BackgroundThygeson’s superficial punctate keratitis (TSPK) is a rare and still poorly understood disease of the ocular surface, responsible for recurrent episodes of photophobia and eye pain. While TSPK is considered as a benign condition, a subset of patients has frequent recurrences or even chronic disease, two situations in which there are currently no therapeutic guidelines. We used a preexisting Facebook TSPK patient support group to assess the clinical journey and the burden of disease of TSPK.ResultsAn online survey was sent to the patient support group. The first part of the questionnaire gathered information on demographics and the patient’s clinical journey [diagnostic modalities, symptoms, duration and frequency of recurrent episodes (RE), efficacy and tolerance to treatments]. The second part focused on quality of life (QoL) using the Ocular Surface Disease-QoL (OSD-QoL) questionnaire. Seventy-two patients out of 595 members of the support group completed the questionnaire during the 3-months study period. Eighty percent of patients developed symptoms before 30 years old, and 47% reported a delay in the diagnosis above 1 year. Sixty percent of patients reported over 5 RE yearly, and 18% of RE lasted more than 3 months. Forty percent of all patients used cyclosporine eyedrops (50% of those with > 5 episodes/year) and it was perceived as effective by 72% of these patients. The impact on daily life activities was judged as severe by 22% of patients, while 38% reported reduced professional activity and 80% were deeply saddened by their eye condition.ConclusionTSPK patients may present with frequent recurrences and/or chronic disease, that result in a severe impact on QoL, and an off-label use of topical immunomodulatory eye drops, suggesting the urgent need for controlled studies. The utility of using social networks for rare ophthalmic disease research includes, faster data collection, data from patients across the globe, and also raises relevant questions about their real needs.

Thygeson's superficial punctate keratopathy: A review and case series.

Thygeson‘s superficial punctate keratitis (TSPK) is a chronic disorder with episodes of exacerbations and remissions which span over years to decades. Typical features of the disease include multiple, grayish white, intraepithelial corneal lesions with minimal or no conjunctival involvement. The exact etiopathogenesis of this entity is unknown. However, it may have a genetic association with HLA-DR3, an antigen proved to be associated with immunogenic responses. Treatment of the disease consists of artificial tears, topical corticosteroids, topical cyclosporine, topical tacrolimus, or usage of soft contact lenses. TSPK should be considered as a diagnosis of exclusion in cases of bilateral superficial punctate keratopathy of long duration. Thirteen patients of TSPK were examined during the last 6 years (2014–2019) at our Institute. Visual acuity was 20/20 to 20/30 in majority cases. All patients required lubricants.

Thygeson’s superficial punctate keratitis

Thygeson's superficial punctate keratitis (TSPK) is a chronic, bilateral epithelial keratitis. Dr Philips Thygeson first reported TSPK in 1950. Although the etiology of TSPK remains unknown, it has been reported to be associated with viral and autoimmune pathologies. The disease course is characterized by exacerbations and remissions. The classical finding on slit lamp examination is the presence of distinctive coarse, raised, oval-shaped corneal epithelium lesions. Patients commonly present with ocular irritation and rarely with reduced visual acuity. Topical corticosteroids are the mainstay of treatment. Other less commonly used treatments included topical cyclosporine, contact lenses and corneal laser.

Effect of Topical Tacrolimus in the Treatment of Thygeson's Superficial Punctate Keratitis

To evaluate topical tacrolimus ointment for treating Thygeson's superficial punctate keratitis (Thygeson SPK). Retrospective interventional case series. setting: Institutional practice. The medical records of 14 patients (9 women; age range, 9-65 years) with Thygeson SPK were reviewed retrospectively. Diagnosis was based on the history and clinical examination. Patients were treated with tacrolimus 0.03% eye ointment instilled into the lower fornix twice daily for the first 2 weeks, followed by nocturnal application. The clinical signs and symptoms were assessed after 1 month of treatment. The drug was tapered with disease improvement. Treatment efficacy and side effects. All patients had bilateral disease (average duration, 6 years). All patients, except 2 who used the medication irregularly, had improved visual acuity (VA), symptoms, and signs as long as the medication was applied. Before treatment 28.57% of patients had VA between 20/30 and 20/50, with improvement after treatment to 20/25 or 20/20. Attempts to withdraw the medication resulted in recurrent disease, and, therefore, treatment was not curative during the study period. No significant local medication side effects were reported. Tacrolimus eye ointment 0.03% was effective for controlling Thygeson SPK for a long period with good patient tolerance and no noticeable local or systemic side effects. During the average 6-year follow-up, treatment was not curative. Randomized studies are difficult to conduct because of the disease rarity.

Clinical analyses of 21 cases of Thygeson's superficial punctate keratitis

To study the clinical features, diagnosis and treatment of Thygeson's superficial punctate keratitis (TSPK). Twenty-one cases diagnosed as TSPK between June 2010 and July 2013 were retrospectively analyzed, including clinical manifestation, characteristics of morphological changes imaged by laser confocal microscopy, treatment and therapeutic effects. All the 21 cases had the same presentation. Slit lamp examination showed several rough punctate intraepithelial opacities, which were usually slightly above the niveau of the surrounding epithelium. No cases had conjunctival congestions. Eight eyes of five patients with TSPK were imaged with a laser confocal biomicroscope. Clusters of highly reflective dots were revealed in the epithelium. The number of Langerhans cells was greatly increased in the basal cell layer of the focal corneal epithelium and the Bowman's layer in ten eyes affected by TSPK. The density of the subepithelial nerve plexus decreased. Some keratocytes had highly reflective cell bodies of irregular size, orientation, and shape in the anterior stroma in the affected eyes. After treatment with low concentration steroid eye drops and antiviral drugs, punctate opacities in all 21 cases were completely absorbed, leaving no scar, and the cure rate was 100%. But TSPK recurred in four cases. All recurrent cases were cured completely after treatment. Thygeson's superficial punctate keratitis is a kind of chronic recurrent superficial keratitis, without conjunctivitis. Confocal microscopic images have certain specificity, help diagnose and contribute to its pathogenesis research. Local use of low concentration steroid eye drops combined with antiviral drugs is effective for TSPK. Clinicians should pay attention to recurrence of TSPK.

Thygeson’s Superficial Punctate Keratitis- Case Report and Review

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.

Reversible presence of corpuscular mature dendritic cells in Thygeson's superficial punctate keratitis

BACKGROUND: Increased intracorneal dendritic cell (DC) density is a common, non-specific in-vivo confocal microscopic finding in keratitis of various etiology. DCs are observed as either mature or immature forms. Mature forms are capable of antigen presentation and may play a key role in the pathophysiology of immune-mediated keratitis. The present article aims to describe the intracorneal density of three morphologically distinct DC types in Thygeson's superficial punctate keratitis (TSPK) before and after treatment. MATERIAL AND METHODS: Four consecutive cases of TSPK were prospectively included into this study. The Heidelberg Retinal Tomograph II, Rostock Cornea Module (HRTII-RCM; Heidelberg Engineering, Heidelberg, Germany) was used for in-vivo confocal microscopy. All layers of central cornea of both eyes were examined. Within each corneal layer, at least five non-overlapping areas were imaged for representative analysis before and one month after treatment initiation. Dendritic cells were classified as mature or immature. Densities of both forms were calculated. Mature cells were further differentiated in predominantly corpuscular and interdigitating forms. RESULTS: Before treatment, mean overall DC density was 369.3 ± 75.6 cells/mm2, and mean ratio of mature to immature forms (MIR) was 1.09 ± 0.9. There were 58.5 % immature forms and 41.5 % mature forms (27.1 % interdigitating DCs, 14.4 % corpuscular DCs). After four weeks of topical treatment with rimexolone 1 %, an overall DC density of 106.1 ± 147.9 and a MIR of 0.53 ± 0.38 was measured. Mean overall DCs decreased by 71.3 %. Immature forms decreased by 58.2 %, mature interdigitating forms by 85.2 %, and mature corpuscular forms by 98.2 % to virtual disappearance. CONCLUSIONS: Successful topical treatment of TSPK is associated with a greater decrease of mature than immature DCs. The reversible intracorneal presence of corpuscular mature dendritic cells may point towards a key role of antigen presenting cells in the pathophysiology of TSPK and serve as an in-vivo confocal diagnostic indicator of immune-mediated keratitis.

A Case of Supratarsal Injection of Triamcinolone in Management of Chronic Thygeson's Superficial Punctate Keratitis

A Case of Supratarsal Injection of Triamcinolone in Management of Chronic Thygeson's Superficial Punctate Keratitis

In-vivo confocal observation of giant dendritic cells in Thygeson's superficial punctate keratitis

In-vivo confocal microscopy of the cornea was performed in a 44 year-old male with an 11-year history of recurrent Thygeson's superficial punctate keratitis as diagnosed by clinical biomicroscopy. On confocal examination, hyperreflective areas, microdots and keratocyte activation were the most pronounced findings in the anterior stroma. A high dendritic cell density was noted in deeper epithelial cell layers and Bowman's membrane. There were 10.3% large mature cells with a mean size of 42 µm, measuring up to 105 µm. After eight weeks of topical treatment with rimexolone 1%, dendritic cell density and the proportion and size of mature dendritic cells had decreased. There were 3.2% mature cells with a mean size of 28 µm. A less corpuscular appearance of mature dendritic cells was noted. The present case serves to describe the reversible presence of uniquely large mature dendritic cells in a patient with severe recurrent Thygeson's superficial punctate keratitis. We suggest such giant dentritic cells and a high proportion of mature forms as a possible indicator of disease severity. Further studies are warranted to test the significance of dendritic cell morphology rather than quantity in Thygeson's superficial punctate keratitis.

Long-term topical cyclosporin A therapy in Thygeson's superficial punctate keratitis: a case report

PurposeTo describe a patient with Thygeson's superficial punctate keratitis successfully treated with long-term cyclosporin A.Case presentationA 15-year-old boy presented with long-term ocular symptoms of foreign body sensation, burning, irritation, tearing, and transient photophobia. One year's treatment with steroidal agents had led to only partial improvement. Clinical and laboratory evaluation yielded a diagnosis of Thygeson's superficial punctate keratitis. Treatment with 0.5% topical cyclosporin A for the last 4.5 years has been associated with symptom resolution and corneal clearing, without side effects.ConclusionTopical cyclosporin A seems to effective and safe for the treatment of Thygeson's superficial punctuate keratitis and should be considered in selective cases when topical steroids fail or in there is a high risk of complications from long-term steroid treatment. Considering the chronicity of Thygeson's superficial punctate keratitis, further prospective studies of long-term cyclosporine A treatment are needed.

Thygeson's superficial punctate keratitis recurrence after laser in situ keratomileusis

Purpose To report a case of recurrent Thygeson's superficial punctate keratitis (SPK) in a patient submitted to photorefractive keratectomy (PRK) in one eye and laser in situ keratomileusis (LASIK) in the fellow eye. Design Observational case report. Methods A 32-year-old woman was diagnosed with Thygeson's SPK 5 years before undergoing PRK on the right eye and LASIK on the left eye to correct −3.00 + 1.50 × 20 and −3.75 sph, respectively. Results The patient presented with recurrence of Thygeson's SPK in the left eye 10 months after the LASIK procedure and no recurrence on the right eye, which was treated with PRK. Conclusions This case report suggests that PRK may be a better option than LASIK in patients with ocular history of Thygeson's SPK. However, no strong conclusion can be established until further studies confirm the hypothesis of a lower recurrence rate of Thygeson's SPK following PRK compared with LASIK.

PCR for varicella zoster virus genome negative in corneal epithelial cells of patients with Thygeson's superficial punctate keratitis.

To find out if varicella zoster virus is the causative agent of Thygeson's superficial punctuate keratitis. Epithelial cells were harvested from the punctuate epithelial lesions 9 patients with Thygeson's superficial punctate keratitis. After DNA extraction polymerase chain reaction was carried out with varicella zoster virus primers. All samples were negative with regard to varicella zoster virus genome. This result suggests that varicella zoster virus is most probably not the causative agent of Thygeson's superficial punctate keratitis.

Thygeson's superficial punctate keratitis: Ten years' experience

Purpose To evaluate the presentation, treatment, and disease course of Thygeson's superficial punctate keratitis. Design Observational case series. Participants Forty patients, diagnosed and managed with Thygeson's superficial punctate keratitis between January 1, 1992, and December 31, 2001, on the Cornea Service at Wills Eye Hospital. Methods Retrospective chart review. Main outcome measures Patient demographics, symptoms, visual acuity, ophthalmic examination, management, duration of disease, and length of follow-up. Results At the time of presentation, the mean patient age was 28.7 years. The most common presenting symptoms included photophobia, blurred vision, and irritation. Thirty of 38 patients without a history of decreased vision (78.9%) initially were seen with visual acuities in both eyes of 20/30 or better. The 8 (21.1%) remaining patients all had visual acuities between 20/40 and 20/50; improvement in vision with treatment was noted in all 3 observed at our institution. Six patients (16%) had unilateral disease, whereas another 2 patients had bilateral involvement develop after unilateral presentation. Thirty-nine patients (97.5%) were treated with topical steroids at some point in their disease course. The patient not managed with steroids was only seen once and was managed with artificial tears for mild symptoms. In addition to steroids, a patient was treated for recurrent episodes with extended-wear contact lens, and another patient was started on topical cyclosporine because of an inability to be tapered off topical steroids. The average duration of disease in the 15 patients who were observed for more than a single year was 11.1 years. Conclusions Thygeson's superficial punctate keratitis is a potentially chronic condition, which might affect people of all ages for years to decades. Corticosteroids are the mainstay of treatment, with extended-wear contact lens and topical cyclosporine reserved as secondary agents.

Confocal microscopy of Thygeson's superficial punctate keratopathy.

To describe the changes seen with the confocal microscope in Thygeson's superficial punctate keratopathy (TSPK). Confocal microscopy was performed on six patients with TSPK presenting to Manchester Royal Eye Hospital from October 1999 to June 2001. Both eyes were examined including the normal fellow eyes of two patients with unilateral TSPK. Images were compared with age-matched controls. Irregular nerve fibers, masked by considerable haze, were seen in the subepithelial nerve plexus immediately above Bowman's membrane in TSPK. Generalized haze was also present in the anterior stroma along with areas of high reflectivity, microdots, and reflective bodies. Keratocytes had highly reflective nuclei and cell bodies of irregular size, orientation, and shape. The changes were related to the duration of TSPK, were not seen in normal fellow eyes, and were also present in areas without lesions. Confocal imaging of TSPK demonstrated considerable abnormalities in the subepithelial nerve plexus, Bowman's membrane, and the anterior stroma that were related to disease duration. Similar changes have been reported in a variety of corneal diseases and following laser corneal surgery. Recent evidence has supported interactions between the epithelium and Bowman's membrane and the anterior stroma in corneal disease and after laser corneal surgery. We speculate that such interactions may have a role in TSPK.

Lokales Fk506 bei entzündlichen Erkrankungen von Hornhaut und Bindehaut - Eine Pilotstudie -

Hintergrund: Für eine lokale Immunmodulation gravierender entzündlicher Erkrankungen von Hornhaut und Bindehaut stehen als zugelassene Medikamente bislang nur Kortikosteroide zur Verfügung. Beachtliche Ergebnisse konnten in der Vergangenheit zwar mit lokalem Cyclosporin A erreicht werden. Es wirkt aber bei weitem nicht bei allen Patienten. Der Wirkmechanismus von Fk506 beruht wie der von Cyclosporin A in erster Linie auf der Inhibition der Transkription von Interleukin-2 in T-Lymphozyten. Es hat aber ein größeres immunsuppressives Potenzial und zudem deutlich bessere Penetrationseigenschaften. Deshalb sollte in einer klinischen Pilotstudie geprüft werden, ob sich dies theoretisch bessere therapeutische Potenzial in der klinischen Praxis wiederfinden lässt. Hierzu wurden Patienten ausgewählt, die refraktär gegenüber konventioneller Therapie waren und somit eine besondere therapeutische Herausforderung bedeuteten. Patienten und Methoden: Fk506 0,06 % wurde initial dreimal täglich bei 15 Patienten mit atopischer Blepharokeratokonjunktivitis, Ulcus Mooren, okulärem Pemphigoid, Keratitis superficialis punctata Thygeson, Nummuli nach Keratoconjunctivitis epidemica, Graft-versus-host-Reaktion der Bindehaut und Steroid-Response-Glaukom nach perforierender Keratoplastik getropft, und danach individuell ausgeschlichen. Ergebnisse: Innerhalb einer Nachbeobachtungszeit von bislang 26 ± 15 Wochen konnte bei 5/15 Patienten eine Verbesserung und bei 5/15 Patienten eine Stabilisierung erreicht werden. Lediglich bei zwei Patienten kam es zu einer Verschlechterung (einmal Progression eines okulären Pemphigoids, einmal Verdacht auf Automutilation). Bei drei Patienten wurde die lokale Fk506-Therapie frühzeitig wegen Nebenwirkungen (Oberflächenirritation) oder Complianceproblemen abgebrochen. Schlussfolgerungen: Lokales Fk506 hat offenbar besonders bei atopischer Keratokonjunktivitis, bei Keratitis superficialis punctata Thygeson und bei Keratitis nummularis ein beachtliches therapeutisches Potenzial. Wie gut es bei diesen und anderen entzündlichen Hornhaut-/Bindehauterkrankungen genau wirkt, muss in den nächsten Jahren mittels randomisierter Studien herausgearbeitet werden. Bevor diese beginnen, sollten aber die bislang zum Teil bestehenden lokalen Nebenwirkungen weiter reduziert werden.

Topical cyclosporin A in Thygeson's superficial punctate keratitis

Since September 1994 we have administered topical cyclosporin A 2% (CSA) in a prospective study to patients with Thygeson's superficial punctate keratitis (TSPK). After our promising short-term results we now present medium-term data of a larger patient group. Topical CSA was administered to 52 eyes of 28 patients with TSPK. Forty-two were adult eyes (group I), 10 children's eyes (group II). Starting with 3 drops daily during the 1st month, CSA was reduced to 1 drop every 2nd day within 4 months and stopped after 6 months. Complete suppression of the typical epithelial and supepithelial opacities could be achieved in 71.5% of cases in group I and 40% in group II as long as therapy was administered; the other patients responded only partially or not at all. Recurrences were a problem during tapering off or shortly after cessation of therapy, but they could again be treated effectively with the initial CSA regime. Thirty-one percent of all adult eyes and 20% of all pediatric eyes seemed to have completely healed during the observation time. In more than two thirds of our adult patients topical CSA 2% suppresses the epithelial and subepithelial opacities for as long as this non-steroid therapy is administered. Definite healing seems to be achieved in almost one third of all adult patients. In another one third, long-term low-dose CSA therapy is necessary before complete healing may be expected. Children probably do not respond to therapy as well as adults. Whereas the only therapeutic alternative, i.e. steroid eye drops, have a significant potential for side effects in the long run, no side effects have been known from low-dose CSA eye drops. We regard CSA eye drops as a significant progress in the symptomatic treatment of TSPK.

Effect of topical cyclosporin A on Thygeson's superficial punctate keratitis.

Thygeson's superficial punctate keratitis (Thygeson's SPK) is a distinct clinical entity, characterized by round conglomerates of discrete, granular, white-gray, fine intraepithelial dots without conjunctival involvement. The only effective treatment with regard to relieving symptoms and diminishing lesions has been topical corticosteroids, but their prolonged use can be associated with severe side-effects. The purpose of this study is to present the long-term results of the use of 2% topical cyclosporin A in olive oil in Thygeson's SPK. Eight patients diagnosed as having Thygeson's SPK were included. All the patients were treated with 2% cyclosporin dissolved in olive oil four times a day for three months, and two times a day for one month before withdrawing therapy. The follow-up period ranged from twelve to twenty-five months. The number of corneal lesions varied between 5 and 15 before treatment. After cyclosporin treatment, no corneal lesion was observed and the cornea remained clear after the follow-up period. In conclusion, 2% cyclosporin in olive oil is a safe alternative to corticosteroids in the treatment of Thygeson's SPK, and resulted in satisfactory control of the condition.

Local cyclosporin A therapy in Thygeson superficial punctate keratitis--a pilot study

It was the purpose of this prospective study to evaluate the effect of topical Ciclosporin 2% on epithelial and subepithelial opacities in Thygeson's superficial punctate keratitis. We administered Ciclosporin A 2% eye drops to 31 eyes of 17 patients with Thygeson's superficial punctate keratitis. The initial dose was 3 drops daily during the first month. It was reduced according to the following scheme: 2 drops in the second month, 1 drop in the third month, 1 drop every second day in the fourth to sixth months. Thereafter therapy was stopped. The opacities were suppressed completely in 21/31 eyes mostly after 4 weeks of therapy and incompletely in 8/31 eyes. Of the 21 eyes with complete suppression, 6/21 showed recurrent opacities when therapy was stopped after six months. 7/21 eyes had no recurrences after cessation of therapy. Follow-up of 8 eyes is currently less than 6 months and these eyes still receive Ciclosporin A 2% eye drops. All patients complained of a slight burning caused by the drops. In the majority of patients with Thygeson's superficial punctate keratitis topical Ciclosporin A 2% suppresses epithelial and subepithelial opacities as long as this non-steroid therapy is administered at a low dose. In a considerable percentage therapy seems to be curative.

Effect of Topical Trifluridine on Thygeson' Superficial Punctate Keratitis

Six eyes of four patients with Thygeson's superficial punctate keratitis were treated with trifluridine 1 % drops. Five of the six treated eyes responded favorably to topical trifluridine therapy. Symptoms and later the signs of the disease disappeared, but more slowly than observed following topical corticosteroid therapy. One patient with an 11-year history of topical corticosteroid dependence for clearing of lesions was treated successfully with trifluridine, and his eyes have remained clear for over one year without therapy. Mild irritation and transient timbal follicle formation were the only recognized side effects. Trifluridine is thus an effective and safe alternative to corticosteroids in the treatment of this condition and may offer a means of treating the steroid-dependent patient.