J Korean Ophthalmol Soc.  2012 May;53(5):728-732.

A Case of Supratarsal Injection of Triamcinolone in Management of Chronic Thygeson's Superficial Punctate Keratitis

Affiliations
  • 1The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.
  • 2Siloam Eye Hospital, Seoul, Korea. nairwiny@naver.com

Abstract

PURPOSE
To report a case of supratarsal injection of triamcinolone for the management of chronic, steroid-dependent Thygeson's superficial punctate keratitis.
CASE SUMMARY
A 37-years-old woman complained of redness, photophobia, and tearing in both eyes, which lasted for 6 years. The slit lamp examination revealed multiple intraepithelial and subepithelial, punctated corneal lesions which were elevated and scattered diffusely upon staining with fluorescein dye in both eyes. The patient was diagnosed with Thygeson's superficial punctate keratitis and treated with 0.1% fluorometholone, 0.05% cyclosporin, and 0.15% ganciclovir in both eyes. After 10 months of follow-up, recurrences were reported twice in the right eye, and 7 times in the left eye. The patient was treated with a supratarsal injection of triamcilonone in both eyes and after injection, the patient was treated only with artificial tears. Four months later, the patient did not complain of any symptoms and her cornea was clear.
CONCLUSIONS
A supratarsal injection of triamcinolone may be an effective method to prevent recurrence of chronic, steroid-dependent Thygeson's superficial punctate keratitis.

Keyword

Keratitis; Thygeson's superficial punctate keratitis; Triamcinolone

MeSH Terms

Cornea
Cyclosporine
Eye
Female
Fluorescein
Fluorometholone
Follow-Up Studies
Ganciclovir
Humans
Keratitis
Ophthalmic Solutions
Photophobia
Recurrence
Tears
Triamcinolone
Cyclosporine
Fluorescein
Fluorometholone
Ganciclovir
Ophthalmic Solutions
Triamcinolone

Figure

  • Figure 1 At initial visit, elevated cornea lesions with discrete round to oval shape scattered diffusely are noted in patient's right eye (A), and her left eye (B). All lesions are entirely intraepithelial or subepithelial opacities elevated above the superficial epithelium and stained with fluorescein (C).

  • Figure 2 During exacerbation, focal opacities were noted in her right eye (A), left eye (B). At 4 months after supratarsal injection of triamcilonone, focal opacities disappeared completely without any scars in her right eye (C), left eye (D).


Reference

1. Thygeson P. Superficial punctate keratitis. J Am Med Assoc. 1950. 144:1544–1549.
2. Nagra PK, Rapuano CJ, Cohen EJ, Laibson PR. Thygeson's superficial punctate keratitis: ten years' experience. Ophthalmology. 2004. 111:34–37.
3. Goldberg DB, Schanzlin DJ, Brown SI. Management of Thygeson's superficial punctate keratitis. Am J Ophthalmol. 1980. 89:22–24.
4. Del Castillo JM, Del Castillo JB, Garcia-Sanchez J. Effect of topical cyclosporin A on Thygeson's superficial punctate keratitis. Doc Ophthalmol. 1996-1997. 93:193–198.
5. Reinhard T, Sundmacher R. Topical cyclosporin A in Thygeson's superficial punctate keratitis. Graefes Arch Clin Exp Ophthalmol. 1999. 237:109–112.
6. Byun YJ, Kim TI, Seo KY. The short-term effect of topical cyclosporine a 0.05% in various ocular surface disorder. J Korean Ophthalmol Soc. 2008. 49:401–408.
7. Wakui K, Komoriya S, Hayashi E, et al. Corneal and epithelial dystrophies. Rinsho Ganka. 1971. 25:1103–1123.
8. Reinhard T, Roggendorf M, Fengler I, Sundmacher R. PCR for varicella zoster virus genome negative in corneal epithelial cells of patients with Thygeson's superficial punctate keratitis. Eye (Lond). 2004. 18:304–305.
9. Tabbara KF, Ostler HB, Dawson C, Oh J. Thygeson's superficial punctate keratitis. Ophthalmology. 1981. 88:75–77.
10. Thygeson P. Clinical and laboratory observations on superficial punctate keratitis. Am J Ophthalmol. 1966. 61(5 Pt 2):1344–1349.
11. Darrell RW, Suciu-Foca N. HLA DR3 in Thygeson's superficial punctate keratitis. Tissue Antigens. 1981. 18:203–204.
12. Quéré MA, Delplace MP, Rossazza C, et al. [Incidence and etiopathogenesis of Thygeson's keratitis]. Bull Soc Ophtalmol Fr. 1973. 73:629–631. [Article in French].
13. Jermak CM, Dellacroce JT, Heffez J, Peyman GA. Triamcinolone acetonide in ocular therapeutics. Surv Ophthalmol. 2007. 52:503–522.
14. Holsclaw DS, Whitcher JP, Wong IG, Margolis TP. Supratarsal injection of corticosteroid in the treatment of refractory vernal keratoconjunctivitis. Am J Ophthalmol. 1996. 121:243–249.
15. Saini JS, Gupta A, Pandey SK, et al. Efficacy of supratarsal dexamethasone versus triamcinolone injection in recalcitrant vernal keratoconjunctivitis. Acta ophthalmol Scand. 1999. 77:515–518.
16. Singh S, Pal V, Dhull CS. Supratarsal injection of corticosteroids in the treatment of refractory vernal keratoconjunctivitis. Indian J Ophthalmol. 2001. 49:241–245.
Full Text Links
  • JKOS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr