Thygeson superficial punctate keratopathy

Introduction to Thygeson's superficial punctate keratopathy Thygeson superficial punctate keratopathy (TSPK) is a chronic occult corneal dermatitis with unknown etiology and unrelated to systemic disease. Long history, intermittent foreign body sensation, mild conjunctival reaction, spontaneous relief or aggravation of symptoms, characteristic keratopathy, usually the conjunctiva is not tired. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific population Mode of infection: non-infectious Complications: leprosy

Thygeson's superficial punctate keratopathy

(1) Causes of the disease

The cause is still unclear. Braley and Lemp reported that the virus was isolated from the corneal epithelium of two patients, but most studies did not produce a virus. Human papilloma virus (HPV) is a possible pathogenic factor because it is A virus that infects the ocular surface and produces tiny inflammation, but the presence of HPV is not detected in the tissue samples of 2 patients using polymerase chain reaction (PCR). Ostler suggested that TSPK may be caused by a lentivirus. Disease, but there is no evidence to support this hypothesis, it is also suggested that allergies are the cause of TSPK, because some patients often have eczema, urticaria or asthma, and are effective for corticosteroid treatment, but smear examination and No evidence of eosinophils and other allergic diseases was found. Darrel found that HLA-DW3 and HLA-DR3 antigens are associated with TSPK, and other diseases associated with these antigens include gluten-sensitive enteropathy. , Addison disease, primary Sjögen syndrome, Graves syndrome, insulin-dependent diabetes and systemic lupus erythematosus.

(two) pathogenesis

The pathogenesis of TSPK is unknown. The conjunctival scrapings show atypical epithelial cells, vacuoles in the cytoplasm, occasional neutrophils, monocytes, degenerative epithelial cells and mucus. Bacterial culture shows normal conjunctival flora, Tabbara 10 cases of 55 TSPK patients were treated with corneal epithelial culture or electron microscopy. It was found that the epithelium was not easy to obtain, suggesting that the basement membrane and its hemidesmosome were not damaged.

Thygeson superficial punctate keratopathy prevention

There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.

Thygeson's superficial punctate keratopathy complications Complications leprosy

Hot, tears and occasional blurred vision.

Thygeson superficial punctate keratopathy symptoms Common symptoms Corneal sensation reduces photophobia keratitis There is a foreign body sensation in the eye. The dark gray turbidity on the cornea is obvious.

Including photophobia, foreign body sensation, burning, tearing and occasional blurred vision, the conjunctiva can be slightly affected, or it may be completely unaffected. The cornea can be seen as a typical epithelial oval or circular point deposit, composed of many scattered, small Granular, gray-white spotted turbid aggregates, these three-dimensional oval or circular epithelial opacity often develop into a bulge that breaks through the center of the epithelial layer, occasionally visible small, hairy filaments that may be composed of mucus, corneal lesions The edges are not neat, sometimes showing a star-like appearance, and these stellate or dendritic shapes are easily misdiagnosed as herpes simplex keratitis.

The lesions ranged from 3 to 20, and occasionally there was slight epithelial and subepithelial edema, but no cell infiltration was observed. The turbidity easily disappeared and the parts were variable, most often involving the corneal center and the visual axis. The natural course of the disease is often 1~ After 2 months, it gradually relieved, and relapsed after 6 to 8 weeks. The quiescent lesion disappeared completely, leaving only the subepithelial scar.

During the progression of the disease, focal opacity can be extended to the superficial epithelium, fluorescein and bengal red (tiger red) staining positive, remission, the lesion is still, the appearance is flat gray dot in the epithelium, can not be stained by fluorescein or bengal red .

Corneal sensation is usually unaffected. In a few patients, corneal sensation will be slightly weakened. The disease is usually caused by both eyes. The incidence of monocular is less than 1/20, the conjunctival response is small or no, the chronic course can last for 20 to 30 years, and chronic. Symptoms and signs may not be effective for treatment, but may be self-relieving, and acute symptoms are effective for treatment.

Thygeson examination of superficial punctate keratopathy

Virology, immunology, and bacteriological examinations can be used to rule out other similar diseases.

No other special auxiliary checks.

Diagnosis and differentiation of Thygeson's superficial punctate keratopathy

diagnosis

Diagnosis based on the characteristics of this disease is not difficult, combined with laboratory tests can be used for exclusion diagnosis.

Differential diagnosis

According to the characteristics of this disease, it is not difficult to distinguish the diagnosis. The diseases identified by it include: staphylococcal inflammatory epithelial keratitis, pneumococcal conjunctivitis, seborrheic blepharitis, dry keratoconjunctivitis, neurotrophicity And exposed keratopathy, as well as spring keratoconjunctivitis and traumatic keratopathy, TSPK can be differentiated from adenoviral keratoconjunctivitis (or epidemic keratoconjunctivitis) by:

1. No symptoms of conjunctivitis.

2. No swollen lymph nodes or swollen eyelids.

3. In contrast to the large invasive lesions in the late stage of epidemic keratoconjunctivitis, TSPK is characterized by intraepithelial chalky turbidity, TSPK should also be associated with varicella-zoster virus keratitis, herpes simplex virus Keratitis, recurrent epithelial erosion syndrome, rosacea, Reiter syndrome, leprosy, measles cornea, and drug keratitis.

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