Thygeson's superficial punctate keratitis

Thygeson's superficial punctate keratitis

Category(ies): Cornea

Contributor: Lucas Lenci, MD; Blake Perry, MD

Photographer: Brice Critser, CRA

In 1950, Dr. Phillips Thygeson reported a case series of 26 patients. These patients classically have a history of cyclical exacerbations and remissions with symptoms of foreign body sensation, photophobia, burning, tearing and occasionally blurring of vision. Symptoms are commonly bilateral but asymmetric. On exam, there are multiple slightly elevated corneal lesions which are round to oval conglomerates of gray, granular "crumblike" subepithelial opacities. These lesions normally negatively stain, but during exacerbations one can see staining with fluorescein dye. There is minimal conjunctival reaction. On average there are 15-20 lesions, with the greatest density being in the central cornea. These patients can present a difficult treatment conundrum. However, typical treatment consists of topical corticosteroids primarily with cyclosporine and bandaged contact lenses as secondary options. Visual prognosis is excellent.

As an interesting side note, Dr. Thygeson was a faculty member of the University of Iowa Department of Ophthalmology in the 1930's.

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Reference:

• Nagra PK, Rapuano CJ, Cohen EJ, Laibson PR. Thygeson's superficial punctate keratitis: ten years' experience. Ophthalmology. 2004; 111(1):34-7
• Thygeson P. Superficial punctate keratitis. J Am Med Assoc. 1950; 144(18):1544-9.

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