Thygeson Superficial Punctate Keratitis

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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


  • 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


  • 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


  • 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)