92 |
6 Typical Cases of Thygeson’s Punctate Epithelial Keratitis (TSPK) |
Case 3: A Happy End (?) After 25 Years of TSPK
Case Report
A 9-year-old boy had irritation, itching, and photophobia in both eyes for a week. The eyes were white but both corneae showed many epithelial lesions that disappeared rapidly with topical cortisone. Seven years later, at the age of 16, the symptoms recurred. He was again treated with topical cortisone, for 3 months. After that, he was followed for a further 20 years. At each visit, both corneae showed several TSPK lesions, but the symptoms were minimal or none without treatment; 19 years after the onset of the second episode (26 years after disease onset), and also a year later, both corneae appeared normal.
Fig. 6.8 Two TSPK lesions showing rounded/abnormal cells (arrowheads). (Composed photograph)
Fig. 6.9 Th e same |
a |
|
lesions (arrows) as in |
||
|
||
Fig. 6.8. (a third one |
|
|
is visible to the left); |
|
|
they are (a) strongly |
|
|
light-reflecting, with |
|
|
fluorescein show (b) |
|
|
yellow (adherent) |
|
|
surface staining, (c) |
|
|
circumscript green |
|
|
staining (short arrow) |
|
|
and surface protru- |
|
|
sions (dark; bowed |
|
|
arrow); (d) shows |
c |
|
rose bengal staining |
||
|
||
of damaged surface |
|
|
cells/cell debris. (The |
|
|
long white arrows are |
|
|
placed in corre- |
|
|
sponding locations; |
|
|
c and d are composed |
|
|
photographs) |
|
b
d
A Happy End (?) After 25 Years of TSPK (Case 3, cont.) |
93 |
A Happy End (?) After 25 Years of TSPK (Case 3, cont.)
a |
b |
c |
d |
|
Fig. 6.10 (a–d) Two TSPK lesions (arrows). The lower one (in focus) has (a and c) indistinct edges, contains abnormal cells (arrowheads), shows (b) circumscript green fluorescein staining (short white arrow), and (c) red rose bengal staining of surface cells/cell debris. (d) shows the upper lesion stained with rose bengal; the arrowhead points to a rounded/abnormal cell. (The arrows and arrowheads in a–c are placed in corresponding locations)