Thygeson's SPK

      also called:

Thygeson's Superficial Punctate Keratitis (SPK), 

Thygeson's Superficial Punctate Keratopathy (SPK),

TSPK

                                    This page was last updated 12 January, 2010

People with Thygeson's sometimes wait years before being correctly diagnosed. Unfortunately, after receiving a correct diagnosis, it is hard to find information about Thygeson's because TSPK is a rare disease.

As I find new, scientifically sound information or useful web sites I'll add that new information. I welcome your input.

If you just read one article, this is on the top of my list, JVF.

Noble, Jason; Boerman, Helen; Jiang, Wei; Martén, Lisa; McCormick, Gregory J.; Pepose, Jay S.; Solomon, Renée; Yeu, Elizabeth; Peer-Reviewed Literature: The Treatment of Thygeson’s Superficial Punctate Keratitis, JUNE 2007, CATARACT & REFRACTIVE SURGERY TODAY, pp. 21-23 ; see also  http://www.crstoday.com/PDF%20Articles/0607/CRST0607_PR.pdf

Jump to the Thygeson Discussion Group 

Due to an unending, high volume of computer-generated SPAM postings, I was forced to restrict anonymous access. You'll need to request an ID and Password to join the Discussion Group. It's fast and easy.

What does Thygeson's look like?  Jump here to see Elena's photos.

 In this photo the eye is illuminated by a slit-lamp. Thygeson's SPK is seen as the tiny lesions -- the white dots -- highlighted to the right of  the yellow arrow.  In many cases the person you see for your eye care may use rose bengal dye to verify the diagnosis. 

Photo  is courtesy of Kimberly K. Reed, O.D., F.A.A.O. To see other close-up photos, click here ® Kim Reed's photos.
 
 
 
 

 

Peer-Reviewed Literature: The Treatment of Thygeson’s
Superficial Punctate Keratitis, June 2007:

CATARACT & REFRACTIVE SURGERY TODAY I JUNE 2007: Bottom Line
Thygeson’s superficial punctate keratitis is a rare and potentially
chronic epithelial keratitis, and its pathogenesis is
poorly understood. Although topical steroids remain the
mainstay of treatment, cyclosporin A can be considered as an
alternative treatment, particularly in patients with a chronic
keratitis and those for whom the use of corticosteroids is
undesirable. Further studies are needed to clarify the role PRK
may have in the management of this condition.
 

 Typical Treatment

Comments

Corneal bandages (soft contact lenses)

Commonly used. Treats the symptoms, but isn't a cure.

NOTE: You cannot combine Lotemax and soft contact lenses (As with all ophthalmic preparations containing benzalkonium chloride, patients should be advised not to wear soft contact lenses when using LOTEMAX."

Topical Steroids (Click here to learn more about a particular medication )

Commonly used. Treats the symptoms, but isn't a cure.

   
Experimental treatments that haven't been fully investigated Comments

Cyclosporine

Limited clinical research; not yet a proven treatment.

2007 Study with eight patients shows efficacy of Cyclosporine.

October 2003: Some new developments: RESTASIS™ ophthalmic emulsion may help. Click here for details.

Laser Surgery

   Confocal Microscopy of Thygeson's Superficial Punctate Keratopathy.

Laser surgery example: Photorefractive keratectomy (PRK) combined with phototherapeutic keratectomy (PTK) as a treatment.

Experimental, some single-case reports, limited clinical research, but not yet proven.

Possible connection between Bowman's Layer and TSPK

 

What is Thygeson's?

What do eye care professionals know about treating it?
 

 

Other eye diseases or background information:

Useful, specific articles

Inflammations: How to Tame The Angry Eye originally from Review of Optometry September 1999 Corneal Atlas

Is a Bandage Lens the Answer For Corneal Healing? from Review of Optometry April 1999 Bandage Lens for Corneal Healing  Click here for other bandage lens information.

Survey of Bandage Lens Use in North America, October-December 2002 from Eye & Contact Lens, Science and Clinical Practice

Interactive CD-ROMs for eye care professionals  

TREATMENT OPTIONS:

 Treatment

Comments

Corneal bandages (soft contact lenses)

Commonly used; treats symptoms, doesn't cure

Topical Steroids -- corticosteroid eye drops

(U.S. National Library of Medicine for more information) or click the FDA link below (you will need to enter the name of the drug or medication once you get to the FDA site)

 

    Fluorometholone ophthalmic -- Marketed as FML Forte Liquifilm® (Allergan) or Flarex® (Alcon).

    Loteprednol -- Marketed as  Alrex®  (loteprednol etabonate ophthalmic suspension 0.2%) or Lotemax®(loteprednol etabonate ophthalmic suspension 0.5%)

Commonly used; treats symptoms, doesn't cure. Use only as needed and with care to avoid or minimize side effects, such as patients with diabetes being more likely to develop cataracts or glaucoma with use of corticosteroids. If used long-term, have an ophthalmologist check interior eye pressure every 6-12 months.

 

NOTE: You cannot combine Lotemax and soft contact lenses (As with all ophthalmic preparations containing benzalkonium chloride, patients should be advised not to wear soft contact lenses when using LOTEMAX."
 

Cyclosporine

Experimental and unproven, but intriguing. See article later in this page...

A 1999 investigation in Germany found positive results in 70% of patients.  And check out another case from James Freund. 

Also: October 2003: Some new developments: RESTASIS™ ophthalmic emulsion may help. Click here for details.

Laser Surgery

Experimental, anecdotal, but not yet proven. (Refer also to the journal 

This other article is a case study of only one patient. It suggests promising results, though the treatment has not yet been evaluated in a controlled study.

Corneal Bandages (Soft Contact Lens) and Topical Steroid Drops are most commonly prescribed for symptom treatment, but do not eliminate the cause.

Cyclosporine, a promising solution?

New report 23 Dec 2008:

Hasanreisoglu , Murat;  and Avisar , Rahamim; Long-term topical cyclosporin A therapy in Thygeson's superficial punctate keratitis: a case report,   Cases Journal 2008, 1:415doi:10.1186/1757-1626-1-415, Published: 23 December 2008

Benitez Del Castillo JM, Benitez Del Castillo JB and Garcia-Sanchez J. Effect of topical Cyclosporin A on Thygeson's superficial punctate keratitis. Documenta Ophthalmologica 1996; 93(3):193-8. 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.

Clinical investigation: Topical cyclosporine A in Thygeson's superficial punctate keratitis;        T. Reinhard, Rainer Sundmacher; Eye Hospital, Heinrich Heine University, Moorenstraße 5, D-40225 Düsseldorf, Germany Tel. +49-0211-8117320, fax: +49-0211-811 6241; 9 March 1998

The March 1999 issue of PRIMARY CARE OPTOMETRY NEWS has an article on page 21 about Dr. James Freund in New Albany, Indiana. He reports that a 1% Cyclosporine solution has been effective in eliminating Thygeson's SPK symptoms.

January 2002 update:

"Treating Thygeson's with cyclosporin. To date it has proved the most effective means of treatment for the condition and the drug is becoming more readily available by pharmacist. I have one patient who is a veterinarian using cyclosporin (Optimune) with great success. It is equally effective in relieving symptoms keratitis sicca associated with Thygeson's. Thank you for referencing my article in primary care optometry March 1999. If you run into patients having difficulty locating cyclosporin please direct them to my website so they can contact me. www.dr4ureyes.com Warmest regards, James Freund"

You can obtain cyclosporine, with your doctor's prescription, from Leiter's Pharmacy, in San Jose, California.

Do you have a question or a technical content to add to this page? If so, click here. 

E-Mail to Webmasteremalbest.gif (26615 bytes)

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In Spring 2000, two Connecticut 7th graders decided to do a science fair project on Thygeson's. These kids did a great job. They won a 3rd prize in the fair. Their site's archived links are old. Click here to check it out.bigline8.gif (2060 bytes)

 

Brief Bibliography

See also: http://en.wikipedia.org/wiki/Tspk

  1. Bartlett JD, Jaanus SD. Clinical Ocular Pharmacology. 3rd ed.
  2. Benitez Del Castillo JM, Benitez Del Castillo JB and Garcia-Sanchez J. Effect of topical Cyclosporin A on Thygeson's superficial punctate keratitis. Documenta Ophthalmologica 1996; 93(3):193-8. 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.  Article also cited at: http://www.springerlink.com/content/c8246275n860735h/
  3. "All About Thygeson's superficial punctate keratopathy", 02 April 2007. Cites as reference: Thygeson P. Superficial punctate keratitis. J Am Med Assoc 1950;144:1544-9. PMID 14794375.
  4. Braley, A.E.K. and Alexander, R.C. Superficial Punctate Keratitis: Isolation of a Virus. Arch Ophthal 1953;50:147-54.
  5. Connell PP, O'Reilly J, Coughlan S, Collum LM, and Power WJ; "The role of common viral ocular pathogens in Thygeson's superficial punctate keratitis" British journal of ophthalmology 91(8):1038-41, 2007 Aug
  6. Darrell RW. Thygeson's superficial punctate keratitis: Natural History and Association with HLA-DR3. Transactions Am Opth Soc 79:486-516, 1981
  7. Darrell RW, Sucia-Foca N. HLA-DR3 in Thygeson's superficial punctate keratitis. Tissue Antigens 1981;18:203-4.
  8. Fite SW, Chodosh J. Photoreactive keratectomy in the setting of adenoviral subepithelial infiltrates. Am J. Opthalmol 1998;126:829-31.
  9. Fite SW, Chodosh J, Photorefractive keratectomy for myopia in the setting of Thygeson's superficial punctate keratitis CORNEA 2001;20:425-426. 
  10. Forstot, S.L. and Binder, P.S. Treatment of Thygeson's Superficial Punctate Keratitis with Soft Contact Lenses. Am J Ophthal 1979;88:186,.
  11. Forstot SL, Perry HD, Donnenfeld ED, Damiano RE. Topical cyclosporin A for the treatment of Thygeson’s punctate keratitis. Ophthalmology. 1996: 103 (suppl):144
  12. Fraunfelder Ft, Roy FH. Thygeson's superficial punctate keratopathy. Current Ocular Therapy. Philadelphia, W B Saunders. pp 158-159
  13. Gock G, Ong K, & McClellan K A. A classical case of Thygeson's superficial punctate keratitis. Aust J Ophthalmol. 1995; 23; 76-77.
  14. Goldberg DB, Schanzlin DJ, Brown SI. Management of Thygeson's superficial punctate keratitis. Am J Ophthalmol 1980; 89:22-24.
  15. Goldstein MH, Feistmann JA, Bhatti MT., Photorefractive keratectomy (PRK) combined with phototherapeutic keratectomy (PTK) as a treatment for a patient with Thygeson's superficial punctate keratopathy, The CLAO journal : official publication of the Contact Lens Association of Ophthalmologists, Inc.;  2002 Oct;28(4):172-3..
  16. Grayson:   Thygeson's Superficial Punctate Keratitis. In Arffa RC. Grayson's Diseases of the Cornea, 4th ed. Mosby, 1997, pp. 323-329.
  17. Hasanreisoglu , Murat; and Avisar , Rahamim; Long-term topical cyclosporin A therapy in Thygeson's superficial punctate keratitis: a case report, Cases Journal 2008, 1:415doi:10.1186/1757-1626-1-415, Published: 23 December 2008
  18. Jabbur NS, O’Brien TP. Recurrence of keratitis after excimer laser keratectomy. J Cataract Refract Surg. 2003;29:198-201.Abbott RL, Forster RK, Superficial punctate keratitis of Thygeson associated with scarring and Salzmann's nodular degeneration. American Journal of Opthalmalogy, 1979;87:296-8
  19. Jones, Barrie R., Differential Diagnosis of Punctate Keratitis, International Ophthalmology Clinics: October 1962 - Volume 2 - Issue 3 - ppg 591-611; Original Article: PDF Only
  20. Kanski JJ. Clinical Ophthalmology: a systematic approach. 3rd ed. Oxford: Butterworth-Heinemann; 1994.
  21. Kawamoto, Koji; Chikama, Tai-ichiro; Takahashi, Norihisa; Nishida, Teruo ; "In vivo observation of Langerhans cells by laser confocal
    microscopy in Thygeson’s superficial punctate keratitis"; Molecular Vision 2009; 15:1456-1462 ; Published 29 July 2009
  22. Lemp, M.A., Chambers R.W., and Lurdy J. Viral Isolation in Superficial Punctate Keratitis. Arch Ophthal 1974; 91:8-10.
  23. Leibowitz:  Thygeson's Superficial Punctate Keratitis. In Leibowitz HM, Waring GO. Corneal disorders: clinical diagnosis and management, 2nd ed. Saunders, 1998, pp. 460-461.
  24. Nagra PK, Rapuano CJ, Cohen EJ, Laibson PR. (Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania 19107, USA.); "Thygeson's superficial punctate keratitis: ten years' experience.", Ophthalmology. 2004 Jan;111(1):34-7.
  25. Nesburn AB, Lowe GH, Lepoff NJ, et al. Effect of topical trifluridine on Thygeson’s superficial punctate keratitis. Ophthalmology 1984; 91:1188-1192
  26. Nesburn, A.B., Lepoff, N., Lowe, G.H. and Maguen, E.:  Use of Trifluorothymidine (TFT) in Thygeson's Superficial Punctate Keratopathy. USC/Estelle Doheny Eye Foundation Residents' and Fellows' Day. 1983     
  27. Netto MV, Chalita MR, Krueger RR. Thygeson’s superficial punctate keratitis recurrence after laser in situ keratomileusis. Am J
    Ophthalmol. 2004;138:507-508.
  28. Noble, Jason; Boerman, Helen; Jiang, Wei; Martén, Lisa; McCormick, Gregory J.; Pepose, Jay S.; Solomon, Renée; Yeu, Elizabeth; Peer-Reviewed Literature: The Treatment of Thygeson’s Superficial Punctate Keratitis, JUNE 2007, CATARACT & REFRACTIVE SURGERY TODAY, pp. 21-23 ; see also  http://www.crstoday.com/PDF%20Articles/0607/CRST0607_PR.pdf
  29. Pettit TH, Meyer KT. The differential diagnosis of superficial punctate keratitis. Int Opthalmol Clin 1984;24:79-92.
  30. Reinhard, T., Roggendorf, M., Fengler, I., and Sundmacher, R.; PCR for varicella zoster virus genome negative in corneal epithelial cells of patients with Thygeson’s superficial punctate keratitis, Eye (2004) 18, 304–305. see also: http://www.nature.com/eye/journal/v18/n3/pdf/6700621a.pdf
  31. Reinhard, T., Sundmacher, Rainer, clinical investigation: Topical cyclosporin A in Thygeson's superficial punctate keratitis, Graefe's Archive for Clinical and Experimental Ophthalmology, ISSN: 0721-832X (printed version), ISSN: 1435-702X (electronic version), Abstract Volume 237 Issue 2 (1999) pp 109-112 
  32. Seo, Kyoung Yul, M.D., Recurrence of Thygeson's Superficial Punctate Keratitis After Photorefractive Keratectomy, Cornea 21(7): 736-737; Oct 2002
  33. Sundmacher R, Press M, Neumann-Haefelin D, et al, Keratitis superficialis punctata Thygeson. Klin Monatsbl Augenheilkd 1977;170:908-16.
  34. Tabbara KF, Ostler HB, Dawson C, Oh J. Thygeson's superficial punctate keratitis. Ophth 1981; 88(1):75-77.
  35. Tantum, L. Superficial punctate keratitis of Thygeson. J Am Optom Assoc 1982; 53(12):985-6.
  36. Thygeson, Phillips,  "Superficial Punctate Keratitis". Journal of the American Medical Association (JAMA), 1950; 144:1544-1549.
  37. Thygeson P, Hogan MJ and Kimura SJ: The unfavourable effect of topical steroid
    therapy on herpetic keratitis. Trans Am Ophthalmic Soc 1960, 58: 245.
  38. Thygeson, P. Further Observations on Superficial Punctate Keratitis. Arch Ophthal 66:158, 1962.
  39. Thygeson, P. Clinical and Laboratory Observations on Superficial Punctate Keratitis. Am J Ophthal 61:1344, 1966.
  40. Van Bijsterveld OP. Mansour KH. Dubois FJ. Thygeson's superficial punctate keratitis. Annals of Ophthalmology. 17(2):150-153, 1985.
  41. Watson SL, Hollingsworth J, Tullo AB., Confocal Microscopy of Thygeson's Superficial Punctate Keratopathy., Cornea, 2003 May; 22(4):294-9.
  42. Yanoff M, Duker JS, et al.: Non-Infectious Keratitis. Ophthalmology. London, Mosby 1999 pp 7.5 
  43. Yolton D. Notes from "Anterior Segment Diseases of the Eye" course, Pacific University College of Optometry, Fall 1996.

Page was last updated on Tuesday, 12 January, 2010

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