Saturday, October 25, 2014

Thygeson's Disease/Superficial Punctate Keratitis

Definition

Thygeson's disease is an eye condition named after Phillips Thygeson, an American physician born in 1903. It is now more commonly known as punctate epithelial keratitis or superficial punctate keratitis. It is a type of inflammation of the cornea.

Description

This problem appears as fine, scattered areas of loss of epithelium from the cornea - the clear part of the surface of the eye. The lesions appear punctate (looking like dots or points) but sometimes can appear dendritic (linear and branching).

Superficial punctate keratitis is uncommon and not communicable. Characteristically, there is no residual scarring and long-term vision problems are rare.

Causes

A variety of conditions - infectious and noninfectious - are associated with this condition. These include:

  • Tear abnormalities
  • Immune reactions
  • Denervation
  • Dystrophies
  • Light (sunlamps, welding arcs) injury
  • Overuse of contacts
  • Abrasions
  • Minor chemical injuries
  • Reactions to topical or systemic medication.

They may result in breakdown of integrity of the corneal epithelium, cellular infiltration, or clouding of the cornea.

Most infectious causes occur in association with viral, chlamydial, or bacterial diseases of the eyelids and conjunctiva.

The rapid response to corticosteroid therapy suggests a hyperimmune or dyskeratotic mechanism, although this has not been proved.

Symptoms

Typically, the patient is young, usually under 40 years of age, and complains of foreign body sensation, photophobia (aversion to light), and tearing.

The coarse punctate epithelial lesions appear anywhere on the cornea but commonly in the central area. The lesions are slightly elevated and composed of a multitude of tiny gray dots.

Attacks usually undergo spontaneous remission in days to weeks, only to recur again within weeks or months. Recurrences may develop over any period of time and have been observed for up to 30 years. Between attacks, it returns to normal.

Treatment

There is no specific treatment for this disorder, but the use of topical corticosteroids can bring dramatic symptomatic relief. The lesions and symptoms may begin to clear after two to three days of treatment.

Caution: Prolonged use of corticosteroids can be associated with severe side-effects.

Soft therapeutic contact lenses worn daily may relieve symptoms and avoid complications associated with continuous wear lenses.

Questions

Are there any tests that cano diagnose the condition?

What treatment do you recommend?

Will you be prescribing any medications? What are the side effects?

Is there a specialist in this area?

Are there any research or experimental studies being conducted on this condition?