BANDAGE CONTACT LENS USE IN THYGESONíS SPK
Herman Kwong, Ralph Gundel, SUNY College of Optometry, New York, NY, Mark Speaker, Laser and Corneal Surgery Associates, New York, NY. A poster session held at the 1999 Annual Meeting of the American Academy of Optometry in Seattle, Washington, Saturday, 11 December 1999.
Thygesonís superficial punctate keratitis is a recurrent bilateral disease of the cornea characterized by focal epithelial keratitis. All age groups are affected with the greatest incidence seen in the second and third decades of life. Patients often report episodes of tearing, foreign body, irritation, photophobia and a mild decrease in vision. Stellate, round, granular, slightly raised dots without associated conjuctival or stromal inflammation are seen on examination.1,2 Fluorescein staining and mild subepithelial opacification may also be present.
39 year old woman presented in our office complaining of a constant foreign body
sensation and irritation greater in the right eye lasting for approximately 2
weeks. The patient also complained
of a slight distance and near blur along with photosensitivity while outdoors.
The patientís ocular history revealed a history of bilateral
Thygesonís SPK which was initially diagnosed in her late 20s, with additional
episodes of reoccurrence. Examination
revealed habitual distance visual acuities of 20/25 in OD and 20/20 in OS. Biomicroscopy showed no abnormalities on lids and conjuctiva
OU. The cornea of the right eye
revealed scattered, slightly raised, multiple white intra- and subepithelial
dot-like infiltrates of various granular densities. (Fig 1,2)
The left eye also revealed similar multiple corneal lesions but with less
invasion of the central visual axis. Both eyes showed positive staining
opacities surrounded by negative staining.(Fig 3)
Prior to our office visit, previous topical treatments given to the
patient included FML and Ocuflox drops
in conjunction with artificial tears. Pred Forte was also attempted by another
physician. None of these treatments proved effective in reducing the patientís
overall symptoms. However the
placement of therapeutic soft contact lenses bilaterally in our office
significantly improved the patientís comfort.
superficial punctate keratitis was first described in 1950.
The cause of the disease is unknown but has been postulated to be viral
in nature due to the resemblance of epithelial lesions found in other viral
infections. Patients are often
symptomatic due to the epithelial erosion from these lesions.
The condition can last from weeks to years and may leave ghostlike
intraepithelial opacities during periods of inactivity.3 Various
treatments have been used depending on the severity of appearance and symptoms.
Mild presentations and symptoms have been treated by close observation
and ocular lubricants. Topical antivirals such as trifluridine 1% and steroids
including FML have been beneficial in providing relief and resolution of
Thygesonís. However steroid use may prolong or exacerbate the course of the
disease further, which may have occurred with our patient due to the lack of
response with steroids.2,4 Upon further questioning, our patient
reported previous success with soft contact lenses during her first bout with
the disease but was not given lenses during subsequent attacks by other doctors.
Although steroids may have been effective in resolving the disease, the
patient still remained symptomatic. This case
indicates why bandage soft contact lenses should be considered as the
first line of therapy in resolving patientís symptoms with or without topical
P. Further observations on superficial puncatate keratitis. Arch Ophthalmol
KF, Ostler HB, Dawson C et al. Thygesonís superficial punctate keratitis.
P. Superficial punctate keratitis. JAMA 1950;144:1544-1549
AB, Lowe GH, Lepoff NJ, et al. Effect of topical trifluridine on Thygesonís
superficial punctate keratitis. Ophthalmology 1984;91:1188-1192
(Not available for posting to this web site)
Hospital Resident Slide Collection, 1989
2,3. Krachmer JH, Palay DA. Cornea Color Atlas 1996;12-11,12-13
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