Steroid Sparing Symptomatic Control of Thygeson’s Superficial Punctate Keratitis (TSPK)

Introduction: Thygeson's superficial punctate keratitis (TSPK) is a chronic, recurrent disorder affecting the anterior surface of the cornea. Common symptoms include photophobia, epiphora, pain and blurred vision. The management of TSPK is challenging, and long-term combined therapy is often required, namely steroids. We present a case of TSPK that was managed with a novel regenerative agent (RGTA) resulting in the symptomatic control of the condition. Methods: Observational case report. Case: A 25-year-old male patient with bilateral TSPK presented with ongoing symptoms of irritation, photophobia and foreign body sensation. Previous treatment included steroids, bandage contact lens, antibiotics and various lubricants. While steroids controlled his symptoms, he was concerned about side effects of long-term use and unwilling to persevere with treatment. He was intolerant to cyclosporin drops. As an alternative, he was started on regenerative agent poly (carboxymethylglucose sulphate) known as Cacicol™. Over weeks of treatment, his symptoms were documented using a pain and photophobia score, and improved considerably. The appearance of his corneal surface also improved although epithelial defects did not completely resolve. Discussion: Literature suggests that medical interventions do not modify the natural history of TSPK and therefore treatment should be aimed at achieving symptomatic relief. During treatment with RGTA, our patient's symptomatic relief was striking. Although, RGTA may not modify the pathogenesis of TSPK, it appears to promote healing of epithelial defects and reduce associated pain, and there is evidence to suggest it may be a useful alternative therapy to control the symptoms of TSPK.