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6 Typical Cases of Thygeson’s Punctate Epithelial Keratitis (TSPK) |
Case 1: A 24-Year History of TSPK
Case Report
A 20-year-old woman su ering from foreign body sensation, tearing, and a distressing photophobia was treated elsewhere with topical steroid, but the symptoms recurred after the treatment was stopped. At presentation, both eyes were slightly injected, and the corneal epithelium showed several grayish epithelial lesions. Topical antibiotics had no e ect. All changes and symptoms disappeared rapidly with topical steroid but recurred each time after the treatment was stopped. During the following 23 years, she was treated with a weak steroid solution (prednisolonesodiumphosphate0.05%).Thetreatmentwasslowlytapered, and during the last 10 years she was using the drops only sporadically. At the last visit, 24 years after onset, she was symptom-free, but both corneae showed 10–15 TSPK lesions each.
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Fig. 6.1 Low-magnification photograph showing that in TSPK the eye occasionally may be injected (the patient’s right eye before treatment)
Fig. 6.2 (a, b) The cornea shows several TSPK lesions (arrows). In (a) is visible their light reflecting property and in (b) their granular appearance. (The arrows are placed in corresponding locations)
A 24-Year History of TSPK (Case 1, cont.) |
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A 24-Year History of TSPK (Case 1, cont.)
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stroma
surface
Fig. 6.3 (a–d) A typical TSPK lesion (long arrows), (a) light-reflecting, (b) appearing granular with rounded/abnormal cells visible at the edge (arrowhead), and (c) showing circumscript green fluorescein staining (short arrow) and surface elevations at the edge (dark; bowed arrow). (d) The superficial location of the lesion and the absence of fluorescein diffusion below the lesion is visible with a narrower light beam. (The long arrows are placed in corresponding locations in all photographs; c–d adapted from [1])
Comment
Typical of TSPK is that the eye is white but sometimes, as in this patient, the eye is injected during an
exacerbation.