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Thygeson Superficial Punctate Keratitis

Updated: Aug 01, 2016
Author: Andrew A Dahl, MD, FACS; Chief Editor: Hampton Roy, Sr, MD more...

OVERVIEW

Background
In 1950, California ophthalmologist Phillips Thygeson described multiple case reports of an unusual
superficial punctate keratitis that he described as a transient, bilateral disease, having coarse
corneal epithelial opacities and no associated stromal involvement. [1]

Today, this condition is known as Thygeson superficial punctate keratitis (TSPK). It is a chronic,
often bilateral, recurring illness, with relapses over years to decades. Multiple, whitish gray,
intraepithelial corneal lesions, with minimal to no conjunctival involvement, are trademark
characteristics of the disease.

Although TSPK has a genetic association with HLA-DR3, controversy exists regarding its exact
etiology.

Artificial tears, topical corticosteroids, topical cyclosporine, and soft contact lenses are the typical
treatment methods for the disease, and the success of these treatments varies according to the
severity of the disease.

Although vision may be mildly decreased during the active disease, the long-term visual prognosis
is excellent.

The cornea of a 33-year-old African American man with active Thygeson superficial punctate keratitis (TSPK).

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Thygeson Superficial Punctate Keratitis: Background, Pathophysiology, ... http://emedicine.medscape.com/article/1197335-overview

Pathophysiology
A review of the literature suggests the pathophysiology of TSPK remains unclear, although viral
and immunogenic components are both likely in the disease's formation.

Epidemiology
Frequency

United States

The frequency of TSPK in the United States is currently unknown.

International

The worldwide frequency of TSPK is unknown.

Mortality/Morbidity

TSPK does not cause mortality and the morbidity of the disease is unknown.

Race

A review of the literature suggests statistics on race for TSPK are currently unknown.

Sex

TSPK has a slight female predilection.

Age

TSPK can affect individuals of all age groups. Cases of TSPK in patients ranging in age from 2.5
years to 70 years have been reported, with a mean age of 29 years. [2]

Clinical Presentation

References

1. Thygeson P. Superficial punctate keratitis. J Am Med Assoc. 1950 Dec 30. 144(18):1544-9.
[Medline].

2. Tabbara KF, Ostler HB, Dawson C, Oh J. Thygeson's superficial punctate keratitis.

Ophthalmology. 1981 Jan. 88(1):75-7. [Medline].

3. Darrell RW. Thygeson's superficial punctate keratitis: natural history and association with HLA
DR3. Trans Am Ophthalmol Soc. 1981. 79:486-516. [Medline].

4. Jones BR. Thygeson's Superficial Punctate Keratitis. Trans Ophthalmol Soc U K. 1963.

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Thygeson Superficial Punctate Keratitis: Background, Pathophysiology, ... http://emedicine.medscape.com/article/1197335-overview

83:245-53. [Medline].

5. Nagra PK, Rapuano CJ, Cohen EJ, Laibson PR. Thygeson's superficial punctate keratitis: ten
years' experience. Ophthalmology. 2004 Jan. 111(1):34-7. [Medline].

6. Thygeson P. Clinical and laboratory observations on superficial punctate keratitis. Am J

Ophthalmol. 1966 May. 61(5 Pt 2):1344-9. [Medline].

7. Arffa RC. Grayson's Diseases of the Cornea. 4th ed. St. Louis: Mosby-Year Book; 1997.

8. Tantum LA. Superficial punctate keratitis of Thygeson. J Am Optom Assoc. 1982 Dec.
53(12):985-6. [Medline].

9. Lemp MA, Chambers RW Jr, Lundy J. Viral isolate in superficial punctate keratitis. Arch
Ophthalmol. 1974 Jan. 91(1):8-10. [Medline].

10. Braley AE, Alexander RC. Superficial punctate keratitis; isolation of a virus. AMA Arch
Ophthalmol. 1953 Aug. 50(2):147-54. [Medline].

11. Reinhard T, Roggendorf M, Fengler I, Sundmacher R. PCR for varicella zoster virus genome
negative in corneal epithelial cells of patients with Thygeson's superficial punctate keratitis.
Eye. 2004 Mar. 18(3):304-5. [Medline].

12. Reinhard T, Sundmacher R. Topical cyclosporin A in Thygeson's superficial punctate keratitis.

Graefes Arch Clin Exp Ophthalmol. 1999 Feb. 237(2):109-12. [Medline].

13. Connell PP, O'Reilly J, Coughlan S, Collum LM, Power WJ. The role of common viral ocular
pathogens in Thygeson's superficial punctate keratitis. Br J Ophthalmol. 2007 Aug.
91(8):1038-41. [Medline].

14. Cheng LL, Young AL, Wong AK, Law RW, Lam DS. In vivo confocal microscopy of
Thygeson's superficial punctate keratitis. Clin Experiment Ophthalmol. 2004 Jun. 32(3):325-7.
[Medline].

15. Watson SL, Hollingsworth J, Tullo AB. Confocal microscopy of Thygeson's superficial
punctate keratopathy. Cornea. 2003 May. 22(4):294-9. [Medline].

16. Kobayashi A, Yokogawa H, Sugiyama K. In vivo laser confocal microscopy findings of

Thygeson superficial punctate keratitis. Cornea. 2011 Jun. 30(6):675-80. [Medline].

17. Tanzer DJ, Smith RE. Superficial punctate keratitis of thygeson: the longest course on
record?. Cornea. 1999 Nov. 18(6):729-30. [Medline].

18. Nesburn AB, Lowe GH 3rd, Lepoff NJ, Maguen E. Effect of topical trifluridine on Thygeson's
superficial punctate keratitis. Ophthalmology. 1984 Oct. 91(10):1188-92. [Medline].

19. Fintelmann RE, Vastine DW, Bloomer MM, Margolis TP. Thygeson Superficial Punctate
Keratitis and Scarring. Cornea. 2012 Apr 10. [Medline].

20. Gock G, Ong K, McClellan K. A classical case of Thygeson's superficial punctate keratitis.
Aust N Z J Ophthalmol. 1995 Feb. 23(1):76-7. [Medline].

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Thygeson Superficial Punctate Keratitis: Background, Pathophysiology, ... http://emedicine.medscape.com/article/1197335-overview

21. Del Castillo JM, Del Castillo JB, Garcia-Sanchez J. Effect of topical cyclosporin A on
Thygeson's superficial punctate keratitis. Doc Ophthalmol. 1996-1997. 93(3):193-8. [Medline].

22. Hasanreisoglu M, Avisar R. Long-term topical cyclosporin A therapy in Thygeson's superficial

punctate keratitis: a case report. Cases J. 2008 Dec 23. 1(1):415. [Medline].

23. Forstot SL, Binder PS. Treatment of Thygeson's superficial punctate keratopathy with soft
contact lenses. Am J Ophthalmol. 1979 Aug. 88(2):186-9. [Medline].

24. Goldberg DB, Schanzlin DJ, Brown SI. Management of Thygeson's superficial punctate
keratitis. Am J Ophthalmol. 1980 Jan. 89(1):22-4. [Medline].

25. Jabbur NS, O'Brien TP. Recurrence of keratitis after excimer laser keratectomy. J Cataract
Refract Surg. 2003 Jan. 29(1):198-201. [Medline].

26. Seo KY, Lee JB, Jun RM, Kim EK. Recurrence of Thygeson's superficial punctate keratitis
after photorefractive keratectomy. Cornea. 2002 Oct. 21(7):736-7; author reply 737. [Medline].

27. Netto MV, Chalita MR, Krueger RR. Thygeson's superficial punctate keratitis recurrence after
laser in situ keratomileusis. Am J Ophthalmol. 2004 Sep. 138(3):507-8. [Medline].

28. Fite SW, Chodosh J. Photorefractive keratectomy for myopia in the setting of Thygeson's
superficial punctate keratitis. Cornea. 2001 May. 20(4):425-6. [Medline].

Media Gallery

The cornea of a 33-year-old African American man with active Thygeson superficial punctate
keratitis (TSPK).

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Contributor Information and Disclosures

Author

Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of
Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health
and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical
Center

Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of
Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American
Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens

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Association of Ophthalmologists, Medical Society of the State of New York, New York State
Ophthalmological Society, Outpatient Ophthalmic Surgery Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology,
Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of
Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma
Society

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical College

of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery
Department, Wills Eye Hospital

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of

Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive
Surgery, Cornea Society, Contact Lens Association of Ophthalmologists, Eye Bank Association of
America, International Society of Refractive Surgery

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for:
Cornea Society, AAO, OMIC, Aerie, Bausch & Lomb, Bio-Tissue, Shire, TearLab<br/>Serve(d) as a
speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of

Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of
Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Richard W Allinson, MD Associate Professor, Department of Ophthalmology, Texas A&M

University Health Science Center; Senior Staff Ophthalmologist, Scott and White Clinic

Richard W Allinson, MD is a member of the following medical societies: American Academy of

Ophthalmology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Robert S Duszak, OD, FAAO Attending Physician, Philadelphia Veterans Affairs Medical Center;
Consulting Staff, Nemours Health Clinic, Mayfair Eye Associates; Adjunct Clinical Faculty, Eye

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Thygeson Superficial Punctate Keratitis: Background, Pathophysiology, ... http://emedicine.medscape.com/article/1197335-overview

Institute of the Pennsylvania College of Optometry

Robert S Duszak, OD, FAAO is a member of the following medical societies: American Geriatrics
Society, American Academy of Optometry, American Optometric Association

Disclosure: Nothing to disclose.

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