Thygesons Superficial Punctate Keratitis (TSPK) Treatment and Management
Various treatments have been used to try and treat Thygeson’s SPK; however, many have been unsuccessful.
Antibiotics are not successful and are ineffective in treating the condition.
In some instances antivirals have been used and have had mixed results resulting in mild improvements with the use of trifluridine. Contrary information also suggests that the use of trifluridine causes Thygeson’s to disappear more slowly, especially compared to patients being treated with corticosteroids alone. Contraindications have been identified with the use of idoxxuridine because it causes scarring and persistent subepithelial ghost opacacities in people suffering from Thygesons Superficial Punctate Keratitis.
Most success has been noted by using topical lubricants (such as artificial tears) to relieve the clinical symptoms presented by sufferers of Thygesons Superficial Punctate Keratitis. Typically it contains 0.9% NaCl and maintains ocular tonicity and thickens precorneal tear film and reduces tear film breakup time. Treatments containing dextran and hydroxymethylcellulose are more viscous and last longer. Artifical tears should be preservative-free to avoid ocular reactions associated with the preservative.
The mainstream treatment is the use of topical corticosteroids, as they manage both the symptoms and clinical symptoms. Speculation exists suggesting that the use of corticosteroids may prolong the natural progression of the disease. However, the initial treatment of topical cyclosporine has been found to be effective in people suffering with Thygesons SPK, with the added benefit of having less adverse side effects compared to using topical corticosteroids.
In severe cases, the use of therapeutic soft contact lenses that are worn on an extended-basis can be useful. However, using contact lenses can increase the risk of microbial keratitis affecting the patient. Contact lenses help to cover the nerves and corneal lesions and prevent the surface of the cornea from constant friction with the conjunctiva while blinking.
Research suggests that topical corticosteroids using Fluorometholone 0.1% (FML 0.1%) or similar low-dose steroid has been most successful, then followed up with stronger steroids, and then using contact lenses or topical cyclosporine. Steroids should be tapered gradually over a period of months, and some patients suffering with Thygeson’s Superficial Punctate Keratopathy require longer term occasional use such as weekly or bi-weekly. The use of the steroids helps with improving patient comfort to control symptoms.
Fluorometholone (FML) inhibits fibrin deposition, capillary dilation, edema, phagocytic migration and of acute inflammatory response and proliferation of capillaries, deposition of collagen and scar formation. Topically applied, it can elevate IOP and causes steroid-response glaucoma.
Research (Fite and Chodosh) has reported that photorefractive keratectomy (PRK) prevented TSPK from recurring in the area of the laser treatment. Seo et al suggested that the rate or Thygeon’s Disease recurring was lower with PRK than with Laser In Situ Keratomileusis (LASIK) treatment. Contrary information also suggests that both forms of laser treatment does not prevent the recurrence of TSPK.
Suggested Link: http://emedicine.medscape.com/article/1197335-treatment