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Symptoms ⬇

Mild-to-moderate foreign body sensation, photophobia, and tearing. No history of red eye. Usually bilateral with a chronic course of exacerbations and remissions, but may not be active in both eyes at the same time.

Signs ⬆ ⬇

Critical

Coarse stellate gray-white corneal epithelial opacities that are often central, slightly elevated, and stain lightly with fluorescein. Underlying subepithelial infiltrates may be present (see Figure 4.8.1).

4-8.1 Thygeson superficial punctate keratitis.

Gervasio-ch004-image003

Other

Minimal-to-no conjunctival injection, corneal edema, anterior chamber reaction, or eyelid abnormalities.

Differential Diagnosis ⬆ ⬇

See 4.1, SUPERFICIAL PUNCTATE KERATOPATHY.

Treatment ⬆ ⬇

Mild

  1. Artificial tears, preferably preservative-free, four to eight times per day.
  2. Artificial tear ointment q.h.s.
NOTE:

Treatment is based more on patient symptoms than corneal appearance.

Moderate to Severe

  1. Mild topical steroid (e.g., fluorometholone 0.1%, fluorometholone acetate 0.1%, or loteprednol 0.2% to 0.5% q.i.d.) for 1 to 4 weeks, followed by a very slow taper. May need prolonged low-dose topical steroid therapy.
  2. If no improvement with topical steroids, a bandage soft contact lens can be tried.
  3. Cyclosporine 0.05% or 0.09% drops daily to q.i.d. or lifitegrast 5% b.i.d. may be an alternative or adjunctive treatment, especially in patients with side effects from steroids.

Follow Up ⬆

Weekly during an exacerbation and then every 3 to 6 months. Patients receiving topical steroids require intraocular pressure (IOP) checks every 4 to 12 weeks.