THYGESON'S SUPERFICIAL PUNCTATE KERATITIS: FROM SUSPİCİON TO DİAGNOSİS
Published 2023
- 27th ESCRS Winter Meeting
Reference: CR30
| Type: Case Report (Cornea Day)
| DOI:
10.82333/f9g2-gq28
Authors:
Zuhal Yıldız* 1
, Aysun Sanal Dogan 1
1Ophthalmology,University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital,Ankara,Türkiye
Purpose
To discuss the approach to Thygeson superficial punctate keratitis and the importance of in-vivo corneal confocal microscopy in the diagnosis and follow-up of the disease due to a case report.
Report of case
A 39-year-old male patient with complaints of blurred vision, redness, watering, stinging and photophobia in both eyes is presented. It was learned that he had been using moxifloxacin and na hyaluronate drops 4X1 with the diagnosis of conjunctivitis and dry eye. The patient was seen by 3 different ophthalmologist due to the aforementioned complaints lasting for 2 months.
On examination, his vision was 0.9 OD and 1 OS. Biomicroscopy revealed minimal conjunctival hyperemia in both eyes, and intra and subepithelial punctate multiple infiltrates with oval and notched edges. Some of this infiltrates was stained positive with fluorescein. OSDI score was 87.5 and fluorescein break-up time was 2 seconds on the right and 3 seconds on the left. Corneal topography, anterior segment OCT, confocal microscopy were performed. Routine blood and TORCH panel were requested. Results were normal, except for CMVIgG positivity.
In confocal microscopy, dendritiform cells were seen in the subbasal layer in a density that could not be seen even in stage 4 dry eyes, dendritiform cells were also observed in the epithelial layers. There were hyperreflective materials in the epithelial layer and active keratocytes clustered under Bowman.
Topical loteprodnol 4x1, sodium hyaluronate 5x1, kabomer gel 4x1 was started as treatment for the patient. On the 3rd day of treatment, the patient's symptoms were relieved. Long-term topical cyclosporine treatment was started. Confocal microscopy and biomicroscopy findings regressed at the 1-month follow-up, and the OSDI score was 27.5.
Conclusion / Take home message
Thygeson superficial punctate keratitis is a rare disease of unknown etiology but thought to develop as a result of immunological reaction. It is a disease with bilateral, recurrent punctate keratitis in young men. In-vivo corneal confocal findings indicate that the disease is characterized by inflammation with regional involvement of the epithelium. The diagnosis of the disease is made by suspicion and exclusion of other diagnoses. Confocal microscopy is helpful in diagnosis and follow-up.