90 6 Typical Cases of Thygeson’s Punctate Epithelial Keratitis (TSPK)
Case 2: A 27-Year History of TSPK with Remissions and Exacerbations
Case Report
A 36-year-old woman presented with a 6-month history of recurrent irritation, burning, and tearing in both eyes. Both corneae showed 20–30 epithelial lesions reminiscent of adenovirus infection. Eleven years later, she presented again with the same symptoms coming and going. Again, adenovirus was suspected, but the patient was referred to the Eye Clinic. Both corneae showed typical TSPK epithelial lesions. To start with, she was treated with prednisolone sodium phosphate 0.05% one or two times a day. During the following 14 years, her symptoms were minimal and she used the drops only sporadically; at each visit, the corneae showed 10–15 epithelial lesions and occasionally a few fine subepithelial opacities that faded away. When last seen, 27 years after onset, she was symptom-free without treatment despite the presence of severalTSPK lesions in both corneae.
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Fig. 6.4 (a, b) Survey of TSPK showing several lesions (arrows) (a) before staining and (b) after the application of fluorescein. The frames indicate the same areas
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Fig. 6.5 (a, b) TSPK lesions (arrows). (a) Before staining their granular appearance and rounded/abnormal cells (arrowheads) within and outside the lesions are visible. (b) shows damaged superficial cells/cell debris staining red with rose bengal. (The arrows are placed in corresponding locations)
A 27-Year History of TSPK with Remissions and Exacerbations (Case 2, cont.) |
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A 27-Year History of TSPK with Remissions and Exacerbations (Case 2, cont.)
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Fig. 6.6 (a, b) TSPK lesions (arrows). (a) shows their granular appearance and an absence of defined edges; rounded/abnormal cells (arrowheads) are present within the lesions and outside them. (b) Shows a circumscript green fluorescein staining (short arrow) and surface elevations (dark; bowed arrow). (The long straight arrows are placed in corresponding locations)
Fig. 6.7 Two TSPK lesions (arrows) containing rounded/abnormal cells (arrowhead); such cells are present also in the in-between areas (arrowheads)