Thygeson's superficial punctate keratitis.

Purpose: Thygeson's superficial punctate keratitis (TSPK) is a chronic and recurrent corneal epitheliopathy. Although first described more than 70 years ago, the precise etiological mechanism and optimal treatment approach for TSPK has not been established. In this paper, we present an up-to date review of the literature and propose a step-by-step management protocol.

Method: A literature search was done on PubMed using keywords including Thygeson's superficial punctate keratitis, punctate keratitis, etiology, management, and treatment. The literature was reviewed and reported.

Results: The main findings of this review include a summary of the main theories behind the cause TSPK; although topical corticosteroids remain the treatment of choice, long-term risks associated with these agents and recent studies have revealed immunomodulatory agents as promising treatment adjuvants or alternatives for TSPK; surgical interventions such as PRK/PTK have been utilized in selected refractory cases; finally we propose a treatment protocol based the best available evidence and clinical experience.

Conclusion: Although the clinical features of TSPK have been well described, the specific cause of TSPK remains inconclusive. Mechanisms proposed including viral infection, immune-mediated, and immune responses to viral infection but require further investigation. More prospective randomized clinical trials comparing efficacy of corticosteroids, tacrolimus, and cyclosporine A (CSA) are required. More evidence is required for surgical interventions such as PRK/PTK.