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Superficial Punctate Keratitis



•Multiple, small discrete lesions of the cornea - Affect epithelial and subepithelial layers


Causes based on distribution of lesions in the cornea:


•Generalized - Acute conjunctivitis, Toxic conjunctivitis, Vernal conjunctivitis

•Central- Adenoviral conjunctivitis, Thygeson’s, CL overwear

•Upper ⅓ - Inclusion Conjunctivitis, Superior limbic Keratoconjunctivitis

•Lower ⅓ - Staphylococcus disease, Exposure keratitis, Entropion

•Lower ⅔- Dry eye, Exposure keratitis, Neurotrophic keratitis

•Zonular- Herpes

•Paralimbal- Adjacent to pterygium/ any other conjunctival lesion

•Linear streak- Tarsal foreign body


Types:


•Superficial punctate epithelial erosions - Slightly depressed spots - visible only after staining with fluorescein


•Superficial punctate epithelial keratitis- Greyish white opacities - visible without fluorescein staining, stains poorly with fluorescein and stain well with rose bengal


•Combined epithelial and subepithelial punctate keratitis


SYMPTOMS:

•Foreign body sensation.

•Tearing.

•Decreasing vision if central cornea affected.


SIGNS:

•Multiple, tiny, pinpoint epithelial defects that stain well with fluorescein.


Look for associated ocular changes:

1. Conjunctival changes

2. Eyelid lesions

3. Limbal changes

4. Abnormal tear function

5. Discharge


TREATMENT:

•Treat underlying disorder.

•Discontinue toxic medications and contact lens wear.

•Preservative- free lubricating eye drops/gel/ointment.

•Topical prophylactic antibiotics.


www.ophthalmobytes.com⁣

Image from Rajan Eye Care Hospital

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