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Thygeson's superficial punctate keratitis in children
Meghal Gagrani1,2, Elizabeth A Conner1,2, Hannah Scanga1,2
1UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Insights
Thygesons
Area of Science:
- Ophthalmology
- Corneal Diseases
Background:
- Thygesons' superficial punctate keratitis (TSPK) is a rare corneal condition.
- Management strategies in pediatric TSPK require further elucidation.
Purpose of the Study:
- To describe the first case series of pediatric Thygesons' superficial punctate keratitis (TSPK).
- To evaluate management outcomes, including visual acuity and treatment response.
- To assess the impact of steroid and cyclosporine use on total steroid exposure.
Main Methods:
- Retrospective chart review of pediatric TSPK cases from 2012-2021.
- Assessment of clinical signs, symptoms, diagnosis, and treatment interventions.
- Evaluation of visual acuity, treatment response, and steroid exposure.
Main Results:
- Fifteen children with TSPK were included, all with bilateral disease.
- Topical fluorometholone (FML) showed an 80% initial response rate.
- Cyclosporine 0.05% use significantly reduced total weekly steroid exposure (p < 0.05).
Conclusions:
- Pediatric TSPK responds well to steroids but frequently recurs, requiring slow tapering.
- Non-response to steroids warrants diagnostic re-evaluation.
- Topical cyclosporine 0.05% is effective in reducing steroid dependency in TSPK management.
Objective:
To describe the first paediatric case series of Thygesons' superficial punctate keratitis (TSPK) with management outcomes.
Methods:
A retrospective chart review was done for all children either diagnosed at initial presentation or referred with TSPK from 01/2012 to 08/2021 at a tertiary children's hospital. Records were assessed for signs, symptoms, diagnosis, steroid and cyclosporine 0.05% use. The main outcome measures were visual acuity, treatment response and total steroid exposure.
Results:
Fifteen children (7 females), mean age at presentation 8 ± 4 years were included. All had bilateral disease and a BCVA of >20/40 in the better eye. All patients received topical fluorometholone 0.1%, (FML) initially. 80% had a good response to FML. Corneal scraping was done to exclude infectious causes in four cases due to poor initial response or clinical suspicion. All 4 needed EUA for scraping and anterior segment OCT, after which 2 had molecularly confirmed TGFBI-related stromal dystrophy. For the rest, slow steroid taper was done every 4-6 weeks and recurrences were treated by increasing steroid frequency. Cyclosporine 0.05% was started in nine patients (69%), 8 ± 6 months after initial presentation. The decrease in total steroid exposure per week after starting cyclosporine was statistically significant (p < 0.05).
Conclusion:
Children with TSPK respond quickly to steroids, however, recurrences are common, necessitating a slow taper. Non-response to steroid needs careful reconsideration of the diagnosis and may necessitate the use of an EUA. Using cyclosporine 0.05% reduces the total steroid exposure in TSPK.
