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Comment
. 2023 Nov;37(16):3455-3460.
doi: 10.1038/s41433-023-02533-9. Epub 2023 Apr 21.

Thygeson's superficial punctate keratitis in children

Meghal Gagrani  1   2 , Elizabeth A Conner  1   2 , Hannah Scanga  1   2 , Jamila G Hiasat  1   2 , Kelly Schooping Tripi  1   2 , Matthew S Pihlblad  1   2 , Vishal Jhanji  2 , Ken K Nischal  3   4
Affiliations
Comment

Thygeson's superficial punctate keratitis in children

Meghal Gagrani et al. Eye (Lond). 2023 Nov.

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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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Slitlamp photos of case 1 and 12.
a Slit lamp pictures of case 1 showing multiple stuck on epithelial lesions with no stromal involvement. b Slit lamp picture of case 12 that show large corneal epithelial lesions with a stuck on appearance, raising a high suspicion for microsporidia (note lesions inferiorly, area marked by red star is an artefact).
Fig. 2
Fig. 2. Slit lamp picture of case 14 with a final molecular diagnosis of TGFB1 stromal dystrophy.
a The lesions (white arrow) in the centre appear very similar to TSPK (area marked with the red star is the filament reflex) b Pictures taken 3 years later with more diffuse lesions are more suggestive of corneal dystrophy.
Fig. 3
Fig. 3. Effect of Cyclosporine 0.05% on Steroid Exposure.
Graph showing average steroid exposure per week before and after starting cyclosporine 0.05% in right eye (a) and left eye (b).
Fig. 4
Fig. 4
Clinical effectiveness guideline for management of Thygeson’s superficial punctate keratitis (SPK) in children.
See this image and copyright information in PMC

Comment on

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