Thygeson superficial punctate keratitis and scarring

Purpose: Thygeson superficial punctate keratitis (TSPK), a chronic, inflammatory disease, has traditionally been taught to resolve spontaneously and without scarring. We present 4 cases with TSPK who 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 period ranged from 1 month to 35 years. All 3 patients developed significant corneal scarring. Case 1 had bilateral corneal thickening and a Salzmann nodule with vascularization. Case 2 had bilateral stromal opacification. Case 3 developed corneal scarring to the point of needing an anterior lamellar corneal transplant. Pathological evaluation of this tissue showed disruption of the Bowman layer with band keratopathy, thickening of the basement membrane, and subepithelial fibrosis. The diagnosis of TSPK in these cases was never in doubt, 2 of the cases having been diagnosed by Dr Thygeson. Conclusions: Prolonged corneal inflammation associated with TSPK can cause visually 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.