IT’S THE EYE OF THE THYGESON

Centro Hospitalar Universitário de Lisboa Central, Portugal

A 55-year-old woman with a history of left eye evisceration due to a complicated herpetic keratitis came to the ophthalmology emergency department complaining of right red eye, blurry vision and pain for four months. She mentioned multiple eye exams throughout this period, with a repeated diagnosis of bacterial conjunctivitis and consecutive courses of different antibiotic drops. On right eye biomicroscopy we could see multiple small and elevated oval and linear corneal intraepithelial opacities with positive fluorescein staining. Conjunctival sac cultures were negative. Anterior Segment Optical Coherence Tomography revealed hyperreflective epithelial and subepithelial deposits corresponding to the areas with elevated lesions seen on ophthalmological exam. These deposits could be clearly seen as elevated above the rest of the corneal surface. We suspected Thygeson's superficial punctate keratitis and started preservative-free dexamethasone drops and artificial tears. The symptoms disappeared after four weeks.

Thygeson’s superficial punctate keratitis is a relatively rare and underdiagnosed entity. We are biased to think in obvious and more common diagnoses, but it is extremely important to do a thorough physical exam and complementary diagnostic tests when necessary.