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Clinical Presentation

• Recurring episodes with irritation, photophobia, blurred vision, and epiphora
• Mostly bilateral in young adults
• Corneal (especially central) epithelial lesions, small, well-defined, gray, granular, sometimes elevated, sometimes star-shaped, weakly staining, haze possible

Differential Diagnosis

• Nummuli (subepithelial infiltrates) in the context of past adenovirus keratoconjunctivitis
  • non-staining, subepithelial, possibly deeper stromal opacities, often larger in size, non-elevated

Treatment

• Local lubricating therapy
• Local steroids: e.g., Dexafree (dexamethasone) gtt 4 times a day
  • Typically, rapid regression of symptoms and findings within hours
• Consider local ciclosporin (Ikervis) 0.1% eye drops once a day
• Consider bandage contact lenses
• Consider phototherapeutic keratectomy

Course

• Recurrent episodes over years, often multiple times a year.
• Initial episodes typically present with the most severe symptoms; subsequent episodes tend to be milder over time

Sources

• Thygeson superficial punctate keratitis
• The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
• Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)