Contact Lens Case Reports
Thygeson's SPK in a Daily Wear Soft Contact Lens Patient
By Patrick J. Caroline, FAAO, & Mark P. André, FAAO
Thygeson's superficial punctate keratopathy (SPK) is a bilateral, non-inflammatory condition of the cornea hallmarked by a coarse, punctate epithelial keratopathy. The condition typically occurs in individuals under the age of 30, although all age groups may be involved, and it runs a chronic course with frequent exacerbations and remissions. The coarse, punctate epithelial lesions are elevated, irregular in shape, gray in color, and can appear anywhere on the cornea but are more commonly seen paracentrally (Figure 1). With Thygeson's, there is never any stromal, anterior chamber, or conjunctival involvement. Patient symptoms include a foreign body sensation, photophobia, and tearing. Acute attacks usually undergo spontaneous remission in days to weeks only to recur again within weeks or months. At this time, the etiology of the disorder is not known.
Figure 1. Coarse, punctate lesions seen in Thygeson's SPK.
Our patient is a 17-year-old female with a three-year history of daily disposable soft contact lenses. The patient presented with the typical Thygeson's triad of symptoms, i.e. foreign body sensation, photophobia, and tearing, that began one day earlier. She reported a similar episode (although not as severe) about one month prior, but her symptoms improved over a course of three days and she did not seek treatment at that time. Slit lamp exam clearly showed the elevated, coarse lesions worse on the right eye (Figure 2) than on the left (Figure 3).
Figure 2. Slit lamp appearance of the patient's right eye.
Figure 3. Slit lamp appearance of the patient's left eye.
Managing Thygeson's SPK
History has shown that the condition does not respond well to a wide range of antibiotic or antiviral therapies, and for the past four decades corticosteroids have been the treatment of choice. This patient was ultimately seen in our ocular disease clinic and managed with a five-day course of topical steroids followed by appropriate tapering. Her signs and symptoms resolved within one week without any ocular consequence.
Some practitioners believe that this rapid response to steroid therapy may suggest an auto or hyper-immune mechanism. Today, because of the frequent recurrence of Thygeson's lesions, some practitioners suggest managing the condition with nonsteroidal anti-inflammatory drops.
Additionally, throughout the past 20 years we have had great success in managing the condition with continuous wear soft contact lenses. Our patient is now being managed with high-Dk continuous wear silicone hydrogel contact lenses, and time will tell us her short- and long-term response to the bandage lens therapy. CLS
Patrick Caroline is an associate professor of optometry at Pacific University. He is also a consultant to Paragon Vision Sciences. Mark André is an associate professor of optometry at Pacific University. He is also a consultant for CooperVision.