Superficial Punctate Keratitis Definition

Superficial punctate corneal lesions due to lacrimal system dysfunction from a number causes (see etiology).

Epidemiology and etiology: Superficial punctate keratoconjunctivitis is a very frequent finding as it can be caused by a wide variety of exogenous factors such as foreign bodies beneath the upper eyelid, contact lenses, smog, etc. It may also appear as a secondary symptom of many other forms of keratitis (see the forms of keratitis discussed in the following section). It can also occur in association with an endogenous disorder such as Thygeson's disease.

Symptoms: Depending on the cause and severity of the superficial corneal lesions, symptoms range from a nearly asymptomatic clinical course (such as in neuroparalytic keratitis in which the cornea loses its sensitivity) to an intense foreign body sensation in which the patient has a sensation of sand in the eye with typical signs of epiphora, severe pain, burning, and blepharospasm. Visual acuity is usually only minimally compromised.

Diagnostic considerations and differential diagnosis: Fluorescein dye is applied and the eye is examined under a slit lamp. This visualizes fine epithelial defects. The specific dye patterns that emerge give the ophthalmologist information about the etiology of the punctate keratitis (Figs. 5.11 a - i).

Treatment and prognosis: Depending on the cause, the superficial corneal changes will respond rapidly or less so to treatment with artificial tears, whereby every effort should be made to eliminate the causative agents (Fig. 5.11). Depending on the severity of findings, artificial tears of varying viscosity (ranging from eyedrops to high-viscosity gels) are prescribed and applied with varying frequency. In exposure keratitis, a high-viscosity gel or ointment is used because of its long retention time; superficial punctate keratitis is treated with eyedrops.

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