Thygeson’s superficial punctate keratitis (TSPK): a paediatric case report and review of the literature

Abstract

Background Thygeson’s superficial punctate keratitis (TSPK) is reportedly a rare disease with an insidious onset, numerous remissions and exacerbations, and a long duration. The corneal lesions are elevated, whitish–grey in colour, and granular in the intraepithelium. A few reported cases of TSPK exist, and paediatric experience is limited. Due to the unknown aetiology and controversial treatment strategies for TSPK, we performed a literature review to summarize the criteria for the diagnosis, treatment and prognosis of TSPK to provide a basis for the treatment of TSPK in paediatric patients. Case presentation The clinical course of a boy with TSPK who repeatedly presented with episodes of tearing, photophobia and foreign body sensation in both eyes is described. Irritation was uncontrollable with antiviral and antibiotic medications, and it was managed by corticosteroids. No recurrence was reported at the 1-year follow-up after corticosteroid replacement and tapering. Conclusions The clinical features, treatment and prognosis between adult and paediatric TSPK patients have many similarities. The diagnosis of TSPK in children is more difficult, leading to missed diagnosis. TSPK needs to be carefully differentiated from other types of keratitis, especially intraepithelial secondary and other infectious ocular surface diseases.

Treatment of immune-mediated keratitis (IMMK) in dogs with immunosuppressants observed with spectral domain optical coherence tomography (SD-OCT)

“…In addition, topical corticosteroids may permit or encourage subepithelial lipid accumulation or deposition and cause additional corneal opacity [ 10 ]. In long-term management of IMMK, topical immunomodulators may be a better choice compared to topical corticosteroids because they are associated with lower incidence of ocular and systemic side effects, and the effect of topical immunomodulators as lacrimostimulants may potentiate the healing of the lesions [ 3 10 11 ].…”

“…The immunosuppressive action of tacrolimus is much greater than that of cyclosporine [ 12 ], and both patients showed promising results when 0.03% tacrolimus was prescribed, suggesting that tacrolimus may be considered when other medications are ineffective or cause complications. In humans, Thygeson’s superficial punctate keratopathy (TSPK) presents similar morphology and response to topical immunosuppressants [ 11 ], and previous studies have reported that topical 0.02% tacrolimus is a safe and effective alternative when unresponsive to topical steroids in TSPK [ 13 ].…”

Thygeson Superficial Punctate Keratitis: A Clinical and Immunologic Review

“…7,8 Although the onset is typically in the second or third decades of life, recent pediatric cases have been described. 9 The duration of the disease has been reported as long as 40 years. 9 The duration of the disease has been reported as long as 40 years.…”

“…9 The duration of the disease has been reported as long as 40 years. 9 The duration of the disease has been reported as long as 40 years. 10 Over the years, many hypotheses have been introduced regarding its origin, among which are infectious, genetic, and inflammatory factors.…”