Thygeson’s superficial punctate keratitis (TSPK)

Session Details

Session Title: Presented Poster Session: Medical Cornea

Venue: Poster Village: Pod 3

First Author: : M.Zebbache ALGERIA

Co Author(s): :    M. Kerboua                       

Abstract Details

Purpose:

To emphasize the importance of the clinical diagnosis of the disease by excluding other causes of punctate epithelial lesions, particularly situations in which corticosteroids are highly contraindicated, even if the diagnosis is delayed. Secondary, to give another argument of the association with HLA DR3 and the autoimmune mechanism.

Setting:

Department of Ophthalmology, Army Central Hsopital, Algeria.

Methods:

Case report of a 46 year old male who came forward for an eye exam complaining of blur at near. He also reported episodes of ocular discomfort progressively increasing for several years without redness. He had no ocular examination in his whole life. We did a thorough ocular evaluation particularly slit lamp examination and photograph with fluorescein test, SD-OCT of the cornea and HLA genotyping. The first treatment was based on lubrificant and antiseptic eye-drops, then, he was treated with a weak steroid solution, at the rate of four drops per day for only few days and a rapid decrease.

Results:

The best visual acuity was better in the right eye. Slit lamp revealed bilateral (but asymmetrical) multiple, grayish-white punctate corneal epithelial lesions distributed mainly in the center, rounded or irregular, which stained with fluorescein. SD-OCT of the cornea shows hyperreflective, superficial zones which correspond to the biomicroscopic lesions. HLA genotyping found the following alleles : HLA DR03, DR13, DQ02 and DQ06. The first treatment having given no result and thanks to the follow-up iconography allowing to note that the opacities have changed, the diagnosis TSPK is then retained. Symptoms vanish rapidly with topical steroids but the opacities took more time.

Conclusions:

TSPK was first described by Thygeson in 1950. The cause of the disease unknown but a significant association between TSPK and HLA-DR3 (as it is the case for our patient) implying a role of immunologic factors. The steroids sensitivity consolidates this hypothesis. The diagnosis approach must focus on eliminating other causes of keratitis in which steroids are not recommended. Paradoxically, SD-OCT is less sensitive than slit-lamp biomicroscopy to determine corneal opacities. This pathology has not, at present, yet delivered all its secrets.

Financial Disclosure:

None