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Punctate Keratitis

Punctate Epithelial Keratoconj


Presentation

  • A discussion of the case presented aims to provide clinicians with a clearer understanding of the clinical findings, etiology, and management of TSPK.[ncbi.nlm.nih.gov]
  • Case presentation A 15-year-old boy presented with long-term ocular symptoms of foreign body sensation, burning, irritation, tearing, and transient photophobia. One year's treatment with steroidal agents had led to only partial improvement.[doi.org]
  • A case report and brief literature review is presented. Paralytic lagophthalmos caused dry eyes and superficial punctate keratitis in our patient.[ncbi.nlm.nih.gov]
  • A 59-year-old woman with a 40-year history of superficial punctate keratitis of Thygeson is presented, providing a forum to discuss the chronicity of the disease, its treatment, and the potential complications.[doi.org]
Vietnamese
  • . — Epidemic keratoconjunctivitis at a Vietnamese refugee camp in Florida. Amer. J. Epidem., 106 , 399, 1977. Google Scholar Copyright information Belgian Society of Ophthalmology, Leuven, Belgium and Dr. W.[link.springer.com]
Hyperkeratosis
  • Carriers have been reported to have dry skin with mild follicular hyperkeratosis and more extensive involvement of the soles. Genetics This is a rare disorder with genetic and clinical heterogeneity.[disorders.eyes.arizona.edu]
Follicular Hyperkeratosis
  • Carriers have been reported to have dry skin with mild follicular hyperkeratosis and more extensive involvement of the soles. Genetics This is a rare disorder with genetic and clinical heterogeneity.[disorders.eyes.arizona.edu]
Foreign Body Sensation
  • A 33-year-old African-American man presented with a complaint of a foreign body sensation in both eyes. After a thorough examination, a diagnosis of TSPK was made, and after appropriate management, complete resolution of the acute disease ensued.[ncbi.nlm.nih.gov]
  • A 15-year-old boy presented with long-term ocular symptoms of foreign body sensation, burning, irritation, tearing, and transient photophobia. One year's treatment with steroidal agents had led to only partial improvement.[ncbi.nlm.nih.gov]
  • Case presentation A 15-year-old boy presented with long-term ocular symptoms of foreign body sensation, burning, irritation, tearing, and transient photophobia. One year's treatment with steroidal agents had led to only partial improvement.[doi.org]
  • Clinical features: Symptoms: Patients usually present with bilateral keratitis Characteristic remissions and exacerbations of tearing, foreign body sensation, and photophobia over several years.[dro.hs.columbia.edu]
  • Symptoms Typically, the patient is young, usually under 40 years of age, and complains of foreign body sensation, photophobia (aversion to light), and tearing.[healthcentral.com]
Corneal Opacity
  • A 29-year-old woman with a 5-year history of decreased visual acuity in both eyes had bilateral honeycomb-shaped corneal opacities, located mainly in the superficial central cornea.[ncbi.nlm.nih.gov]
  • Clinically it appears as multiple, punctate or circular, gray, superficial corneal opacities that may or may not be ulcerated (Figure 11.22 ). The condition is bilateral and lesions are frequently symmetric.[aibolita.com]
  • Every attempt to taper the cyclosporin A treatment resulted in a reappearance of symptoms and of corneal opacities. At the most recent follow-up visit, 4.5 years after presentation, the patient was still applying cyclosporin A drops 3 times daily.[doi.org]
  • The most common causes of loss of corneal transparency are: Corneal Oedema Drying of Cornea Depositions on Cornea Inflammations of Cornea Corneal Degenerations Dystrophies of cornea Vascularization of cornea Scarring of Cornea Corneal Opacities [ edit[en.wikibooks.org]
Red Eye
  • Superficial Punctate Keratitis: Symptoms The symptoms of superficial punctate keratitis include: Red eyes Dry eyes Watery eyes Blurred vision Eye pain Eye sensitivity to light Burning sensation in the eye Red eyes are a common symptom of superficial punctate[study.com]
  • CL-induced red eye (CLARE), or CL-associated infiltrative keratitis . Arises as a result of extended CL wear and is associated with an acute onset of red eye associated with infiltrates. It may resemble microbial keratitis (refer if unsure).[patient.info]
  • Evaluation of the red eye. . Accessed Sept. 18, 2018. Austin A, et al. Update on the management of infectious keratitis. Ophthalmology. 2017;124:1678. What is bacterial keratitis? American Academy of Ophthalmology. . Accessed Sept. 18, 2018.[mayoclinic.org]
  • He reported sore, red eyes and variable vision for the previous two months and was wearing hydrogel contact lenses that had been prescribed in the United Kingdom about one year before.[siliconehydrogels.org]
  • Ocular symptoms may include dry or red eyes, foreign-body sensation, pruritus, photophobia, pain, visual changes, and even complete loss of vision.[aafp.org]
Conjunctival Hyperemia
  • SPK in 5 corneal regions, conjunctival hyperemia, tear breakup time (TBUT), and intraocular pressure (IOP) were examined in a masked manner at baseline, 1 month, and 3 months.[ncbi.nlm.nih.gov]
  • In phase 3 clinical trials of 0.05% and 0.1% ophthalmic emulsions of cyclosporin for the treatment of dry eye disease, the most common treatment-related adverse events were burning eye, stinging eye, and conjunctival hyperemia.[doi.org]
Burning Eyes
  • In phase 3 clinical trials of 0.05% and 0.1% ophthalmic emulsions of cyclosporin for the treatment of dry eye disease, the most common treatment-related adverse events were burning eye, stinging eye, and conjunctival hyperemia.[doi.org]
Quadriplegia
  • Recessive Mutations in ELOVL4 Cause Ichthyosis, Intellectual Disability, and Spastic Quadriplegia. Am J Hum Genet. 2011 Nov 16.[disorders.eyes.arizona.edu]

Workup

HLA-DR3
  • Although its exact etiology is controversial, TSPK has a genetic association with HLA-DR3, an antigen associated with immunogenic responses.[ncbi.nlm.nih.gov]
  • Although TSPK has a genetic association with HLA-DR3, controversy exists regarding its exact etiology.[emedicine.medscape.com]
  • Br J Ophthalmol . 2007;91(8):1038-41. 7.0 7.1 7.2 Darrell RW: Thygeson's superficial punctate keratitis: natural history and association with HLA-DR3, Trans Am Ophthalmol Soc 79:486, 1981. 8.0 8.1 8.[eyewiki.aao.org]
  • […] is suggested by the presence of white blood cells in the conjunctiva and corneal epithelium, "by the extended course of the disease, by the therapeutic efficacy of topical corticosteroids," and by the presence in some individuals of an antigen called HLA-DR3[webeye.ophth.uiowa.edu]

Treatment

  • Before treatment 28.57% of patients had VA between 20/30 and 20/50, with improvement after treatment to 20/25 or 20/20.[ncbi.nlm.nih.gov]
  • The number of corneal lesions varied between 5 and 15 before treatment. After cyclosporin treatment, no corneal lesion was observed and the cornea remained clear after the follow-up period.[ncbi.nlm.nih.gov]
  • Ophthalmologists must exercise care when using long-term corticosteroid treatment in this condition.[doi.org]

Prognosis

  • Cases of TSPK in patients ranging in age from 2.5 years to 70 years have been reported, with a mean age of 29 years. [2] Prognosis Regardless of the treatment method selected, the visual prognosis in patients with TSPK is excellent. [2, 3, 4] Patient[emedicine.medscape.com]
  • Outcome/Prognosis The visual outcome of TSPK is generally good, although some individuals have experienced slightly reduced visual acuity. Bibliography Gock G, Ong K, McClellan K. A classical case of Thygeson's superficial punctate keratitis.[webeye.ophth.uiowa.edu]
  • Treatments vary based on stage of disease/degree of ulceration if infectious keratitis develops Prognosis and Future Directions Crack eye syndrome is multifactorial in etiology Results in extensive and chronic corneal changes Repeated corneal trauma and[eyewiki.org]
  • Prognosis Most problems caused by CLs will make a full recovery following removal of the lens. Neovascularisation and microbial keratitis can cause permanent visual impairment if not treated quickly and adequately.[patient.info]

Etiology

  • Although its exact etiology is controversial, TSPK has a genetic association with HLA-DR3, an antigen associated with immunogenic responses.[ncbi.nlm.nih.gov]
  • Neurophysiological studies can help to locate the anatomical level of damage at the ophthalmic branch of the trigeminal nerve, confirming the suspected etiology of stroke, and demonstrating that prior vascular involvement coincides with the location of[ncbi.nlm.nih.gov]
  • Abstract Superficial punctate keratitis of Thygeson is a distinctive clinical entity, of probable viral etiology, that can be managed by the optometrist. Diagnosis is made on clinical impression and elimination of other possible causes.[ncbi.nlm.nih.gov]
  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • The etiology remains unknown.[ncbi.nlm.nih.gov]

Epidemiology

  • Marquezan MC, Nascimento H, Vieira LA, Serapião M, Ghanem RC, Belfort R, Freitas D Virological and epidemiological analysis of coxsackievirus A24 variant epidemic of acute hemorrhagic conjunctivitis in Okinawa, Japan, in 2011.[medicbind.com]
  • . — Pharyngoconjunctival fever, epidemiological studies of a recently recognized disease entity. J.A.M.A., 157 , 1083, 1955.[link.springer.com]
  • Epidemiology Frequency United States The frequency of TSPK in the United States is currently unknown. International The worldwide frequency of TSPK is unknown.[emedicine.medscape.com]
  • Corneal lesions show a tendency for the central pupillary area distribution with mild or absent conjunctival inflammation and no association to systemic disease. [1] [2] There are no specific data on the epidemiology of the disease.[eyewiki.aao.org]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology A review of the literature suggests the pathophysiology of TSPK remains unclear, although viral and immunogenic components are both likely in the disease's formation.[emedicine.medscape.com]
  • PATHOPHYSIOLOGY The etiology of Thygeson's SPK is unknown. Research indicates, however, that the condition may be caused by a chronic subclinical viral infection affecting the deeper layers of the corneal basal epithelium.[web.archive.org]
  • The pathophysiology of TSPK remains unknown. Both, viral and immunologic mechanisms have been implicated. Adenovirus, herpes simplex virus, and varicella zoster virus, have all been implicated as a possible causes of the disease.[eyewiki.aao.org]
  • […] scan OU Retina flat, no detachments, no masses OU Crack eye syndrome characterized by: Epitheliopathy/epithelial trauma Superficial punctate keratitis Epithelial defects Microbial keratitis Stromal melt and corneal perforation Neurotrophic keratopathy Pathophysiology[eyewiki.org]

Prevention

  • Long-term maintenance therapy with cyclosporine may prevent recurrence of corneal ulcers. Contact[aibolita.com]
  • […] and conditions: • Injuries due to arc welding overuse of lamps • Exposure to chemicals • Reactions to drugs prescribed for unrelated disorders • Immune or allergic reaction Treatment Eye drops used to act as artificial tears help lubricate the eye and prevent[optometrist.com.au]
  • Prevent Blindness America. 500 East Remington Road, Schaumburg, IL 60173. (800) 331-2020.. OTHER "Infection-causing Organism Dictates Microbial Keratitis Treatment." Slack Inc. Page. 21 May 1998. "Keratitis." ThriveOnline. 20 May 1998.[dxline.info]
  • Preventing viral outbreaks Some forms of viral keratitis can't be completely eliminated.[mayoclinic.org]
  • Superficial squamous cells of the epithelium are surrounded by a continuous band of tight junctions that prevent fluid from entering the stroma.[reviewofcontactlenses.com]

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