Thygeson´s Keratitis - Clinical Characteristics and Therapeutical Modalities

Overview

Purpose:
The evaluation of clinical manifestations and therapeutical modalitiesThygeson´s keratitis (Thygeson´s superficial punctate keratitis - TSPK) in a groupof patients with long follow-up in the Cornea and Immunology Clinic of the Departmentof Ophthalmology, General Teching Hospital, Charles University in Prague.Patients and Methods: The group of 7 patients (13 eyes) at the mean age of 20,7years (9-39) with clinical diagnosis of TSPK was evaluated retrospectively. Thecourse of the disease, symptoms and signs of the disease, efficacy of the therapyand primary established diagnosis were evaluated.Results: The average onset of the disease was 12,5 years (6-27) and the averageduration was 6 years (2-10). TSPK was bilateral in six patients, while unilateralthe disease was only in one patient. The clinical picture was characterized by recurrent episodes of photophobia, tearing and burning and foreign body sensationin the eyes. The examination revealed whitish fine granular asterisk-form ordendriform intraepithelial opacities, sometimes slightly above the niveau of thesurrounding epithelium. In the acute phase the corneal epithelium above thelesions was disrrupted. Subjective symptoms and sometime also the objectivefindings diminished after local corticosteroids administration. The most commonprimary diagnoses the TSPK patients were treated for herpetic keratitis.Conclusion: TSPK is a rare, relapsing corneal disease with the onset mostly in thefirst and third decade of life. TSPK is mostly bilateral, but may be also unilateraland findings are asymetrical in almost all cases. Relapses frequently occur inconnection with physical or psychological stress. Concerning the permanentdamage to the cornea and potential to decrease visual acuity TSPK can beconsidered as a benign and during several years self-limited disease. Subjectivesymptoms however may significantly deteriorate patient´s quality of life. Localtreatment with corticosteroids diminishes subjective symptoms, number andduration of relapses but does not cure the disease. The disease is often misdiagnosedand treated incorrectly.

Key words:
Thygeron’s keratitis, keratitis superficialis punctata, corticoids