Cornea
Thygeson's Superficial Punctate Keratitis
Also known as: Thygeson's SPK, Thygeson SPK, superficial punctate keratitis, Thygeson keratitis, TSPK, punctate epithelial keratitis, coarse SPK bilateral, white quiet eye SPK
Filed as: Routine
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
A chronic, recurrent, bilateral corneal disease of unknown aetiology characterised by coarse, elevated, grey-white epithelial deposits that stain poorly with fluorescein but well with rose bengal. The conjunctiva is white and quiet. No limbal injection, no associated blepharitis, no corneal infiltrate. Aetiology is uncertain — viral or immune-mediated mechanisms are proposed. Responds to topical steroids but recurs on cessation.
Recognition
Symptoms: what patients report
- Bilateral photophobia — often marked.
- Foreign-body sensation — grittiness.
- Tearing.
- Mild blurred vision during flares.
- No discharge.
- Recurrent episodic course — episodes lasting weeks to months separated by remissions.
- White, non-red eyes despite symptoms — the hallmark discordance.
Signs: what the examination shows
- Coarse, elevated, grey-white epithelial deposits scattered across the cornea — NOT associated with the limbus.
- Deposits are raised above the epithelial surface — they can be seen with direct focal illumination.
- Rose bengal staining: positive — deposits stain with rose bengal.
- Fluorescein staining: variable — lesions may take up fluorescein, and stain more reliably with rose bengal or lissamine green; fluorescein uptake does not exclude Thygeson's.
- Conjunctiva: white and quiet — NO limbal injection, no chemosis.
- No corneal vascularisation, no infiltrate, no stroma involvement.
- Bilateral involvement — both eyes affected, often asymmetrically.
What OptoGuide™ covers for thygeson's superficial punctate keratitis
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Thygeson Superficial Punctate Keratitis — EyeWiki
- Anterior Eye Disease and Therapeutics A-Z (Bruce & Loughnan) — standard reference text
- Thygeson’s superficial punctate keratitis. Mandal N, Yeung SN, Tadrous C, Iovieno A. Graefe's Archive for Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle Ophthalmolo
- In Vivo Confocal Microscopy of Toxic Keratopathy. Chen Y, Le Q, Hong J, Gong L, Xu J. Eye (London, England). 2017;31(1):140-147.
- The Global Incidence and Diagnosis of Fungal Keratitis. Brown L, Leck AK, Gichangi M, Burton MJ, Denning DW. The Lancet. Infectious Diseases. 2021;21(3):e49-e57.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.