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.

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).

Figure 4.8.1: Thygeson superficial punctate keratitis.

Other

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

See 4.1, Superficial Punctate Keratopathy. 

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% to 0.1% 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.

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.