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2010 OMIG, Abstract 22

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Thygeson’s superficial puncate keratitis and scarring
R.E. Fintelmann, M.M. Bloomer, T.P. Margolis, Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA

Purpose: Thygeson’s superficial punctate keratitis, a chronic, inflammatory disease, has traditionally been taught to resolve spontaneously and without scarring. We present four cases with Thygeson’s superficial punctate keratitis that developed sight-altering scarring after a prolonged disease course.
Methods: Retrospective chart review of cases seen at the Proctor Medical Group.
Results: Patients age ranged from 31 to 68 years. All patients were male and had been symptomatic from 2 to 53 years. Follow-up ranged from 1 month to 35 years. All four patients developed significant corneal scarring. Case 1 had bilateral corneal thickening and a Salzmann’s nodule with vascularization. Case 2 had bilateral stromal opacification. Case 3 had peripheral scarring after having hundreds of peripheral lesions that went untreated for several years. Case 4 developed corneal scarring to the point of needing an anterior lamellar corneal transplant. Pathological evaluation of this tissue showed disruption of Bowman’s layer with band keratopathy, thickening of the basement membrane and subepithelial fibrosis. The diagnosis of Thygeson’s SPK in these cases was never in doubt, two of the cases having been diagnosed by Dr. Thygeson.
Conclusion: Prolonged corneal inflammation associated with Thygeson’s superficial punctate keratitis can cause visual significant scarring of the anterior corneal stroma. In those patients with chronic disease the use of a topical corticosteroid may be needed not just for comfort but to reduce the risk of corneal scarring.

Disclosure code: N

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