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Thygeson’s superficial punctate keratitis in children

Eye volume 37, pages 3455–3460 (2023)Cite this article

Subjects

Abstract

Objective

To describe the first paediatric case series of Thygesons’ superficial punctate keratitis (TSPK) with management outcomes.

Methods

A retrospective chart review was done for all children either diagnosed at initial presentation or referred with TSPK from 01/2012 to 08/2021 at a tertiary children’s hospital. Records were assessed for signs, symptoms, diagnosis, steroid and cyclosporine 0.05% use. The main outcome measures were visual acuity, treatment response and total steroid exposure.

Results

Fifteen children (7 females), mean age at presentation 8 ± 4 years were included. All had bilateral disease and a BCVA of >20/40 in the better eye. All patients received topical fluorometholone 0.1%, (FML) initially. 80% had a good response to FML. Corneal scraping was done to exclude infectious causes in four cases due to poor initial response or clinical suspicion. All 4 needed EUA for scraping and anterior segment OCT, after which 2 had molecularly confirmed TGFBI-related stromal dystrophy. For the rest, slow steroid taper was done every 4–6 weeks and recurrences were treated by increasing steroid frequency. Cyclosporine 0.05% was started in nine patients (69%), 8 ± 6 months after initial presentation. The decrease in total steroid exposure per week after starting cyclosporine was statistically significant (p < 0.05).

Conclusion

Children with TSPK respond quickly to steroids, however, recurrences are common, necessitating a slow taper. Non-response to steroid needs careful reconsideration of the diagnosis and may necessitate the use of an EUA. Using cyclosporine 0.05% reduces the total steroid exposure in TSPK.

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Fig. 1: Slitlamp photos of case 1 and 12.
Fig. 2: Slit lamp picture of case 14 with a final molecular diagnosis of TGFB1 stromal dystrophy.
Fig. 3: Effect of Cyclosporine 0.05% on Steroid Exposure.
Fig. 4

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Data availability

The data that support the findings of this study are not openly available but are available from the corresponding author upon reasonable request.

References

  1. Thygeson P. Clinical and laboratory observations on superficial punctate keratitis. Am J Ophthalmol. 1966;61:1344–9.

    Article  CAS  PubMed  Google Scholar 

  2. Connell PP, O’Reilly J, Coughlan S, Collum LMT, Power WJ. The role of common viral ocular pathogens in Thygeson’s superficial punctate keratitis. Br J Ophthalmol. 2007;91:1038–41.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kawamoto K, Chikama T, Takahashi N, Nishida T. In vivo observation of Langerhans cells by laser confocal microscopy in Thygeson’s superficial punctate keratitis. Mol Vis. 2009;15:1456–62.

    PubMed  PubMed Central  Google Scholar 

  4. Darrell RW, Suciu-Foca N. HLA DR3 in Thygeson’s superficial punctate keratitis. Tissue Antigens. 1981;18:203–4.

    Article  CAS  PubMed  Google Scholar 

  5. Chan TCY, Chau HHT, Bhat AK, Nischal KK, Jhanji V. Thygeson’s superficial punctate keratitis. J EuCornea. 2019;3:5–8.

    Article  Google Scholar 

  6. Priyadarshini SR, Roy A, Das S. Thygeson’s superficial punctate keratopathy: a review and case series. Indian J Ophthalmol. 2021;69:806–11.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Tang XJ, Liu Q, Pi LH, Chen XK, Chen L. Thygeson’s superficial punctate keratitis (TSPK): a paediatric case report and review of the literature. BMC Ophthalmol. 2021;21:64.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Tabbara KF, Ostler HB, Dawson C, Oh J. Thygeson’s superficial punctate keratitis. Ophthalmology. 1981;88:75–7.

    Article  CAS  PubMed  Google Scholar 

  9. Marquezan MC, Nascimento H, Vieira LA, Serapião M, Ghanem RC, Belfort R, et al. Effect of Topical Tacrolimus in the Treatment of Thygeson’s Superficial Punctate Keratitis. Am J Ophthalmol. 2015;160:663–8.

    Article  CAS  PubMed  Google Scholar 

  10. Hasanreisoglu M, Avisar R. Long-term topical cyclosporin A therapy in Thygeson’s superficial punctate keratitis: a case report. Cases J. 2008;1:415.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Nagra PK, Rapuano CJ, Cohen EJ, Laibson PR. Thygeson’s superficial punctate keratitis: ten years’ experience. Ophthalmology. 2004;111:34–7.

    Article  PubMed  Google Scholar 

  12. Fintelmann RE, Vastine DW, Bloomer MM, Margolis TP. Thygeson superficial punctate keratitis and scarring. Cornea. 2012;31:1446–8.

    Article  PubMed  Google Scholar 

  13. Abbott RL, Forster RK. Superficial punctate keratitis of Thygeson associated with scarring and Salzmann’s nodular degeneration. Am J Ophthalmol. 1979;87:296–8.

    Article  CAS  PubMed  Google Scholar 

  14. Ames P, Galor A. Cyclosporine ophthalmic emulsions for the treatment of dry eye: a review of the clinical evidence. Clin Investig. 2015;5:267–85.

    Article  CAS  Google Scholar 

  15. Okumus S, Coskun E, Tatar MG, Kaydu E, Yayuspayi R, Comez A, et al. Cyclosporine a 0.05% eye drops for the treatment of subepithelial infiltrates after epidemic keratoconjunctivitis. BMC Ophthalmol. 2012;12:42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Reinhard T, Sundmacher R. Topical cyclosporin A in Thygeson’s superficial punctate keratitis. Graefes Arch Clin Exp Ophthalmol. 1999;237:109–12.

    Article  CAS  PubMed  Google Scholar 

  17. Shoughy SS, Tabbara KF. Topical tacrolimus in Thygeson superficial punctate keratitis. Cornea. 2020;39:742–4.

    Article  PubMed  Google Scholar 

  18. Goldberg DB, Schanzlin DJ, Brown SI. Management of Thygeson’s superficial punctate keratitis. Am J Ophthalmol. 1980;89:22–4.

    Article  CAS  PubMed  Google Scholar 

  19. Forstot SL, Binder PS. Treatment of thygeson’s superficial punctate keratopathy with soft contact lenses. Am J Ophthalmol. 1979;88:186–9.

    Article  CAS  PubMed  Google Scholar 

  20. Gock G, Ong K, McClellan K. A classical case of Thygeson’s superficial punctate keratitis. Aust NZ J Ophthalmol. 1995;23:76–7.

    Article  CAS  Google Scholar 

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Funding

This work was supported by NIH CORE Grant P30 EY08098 to the Department of Ophthalmology, the Eye and Ear Foundation of Pittsburgh, and from an unrestricted grant from Research to Prevent Blindness, New York, NY.

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Authors and Affiliations

  1. UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Meghal Gagrani, Elizabeth A. Conner, Hannah Scanga, Jamila G. Hiasat, Kelly Schooping Tripi, Matthew S. Pihlblad & Ken K. Nischal

  2. UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Meghal Gagrani, Elizabeth A. Conner, Hannah Scanga, Jamila G. Hiasat, Kelly Schooping Tripi, Matthew S. Pihlblad, Vishal Jhanji & Ken K. Nischal

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  1. Meghal Gagrani
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  2. Elizabeth A. Conner
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  8. Ken K. Nischal
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Contributions

KKN conceived the idea of the study, MG, LC and JH designed the clinical effectiveness protocol. MG, KT, HS, MP were responsible for conducting the search and screening potentially eligible subjects. MG extracted and analysed data. MG and KKN interpreted the results and wrote the report. VJ provided feedback on the report.

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Correspondence to Ken K. Nischal.

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Gagrani, M., Conner, E.A., Scanga, H. et al. Thygeson’s superficial punctate keratitis in children. Eye 37, 3455–3460 (2023). https://doi.org/10.1038/s41433-023-02533-9

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