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Thygeson’s Superficial Punctate Keratitis

Keratitis is the generic name given to any kind of inflammation of the cornea, the dome shaped translucent membrane at the front of the eye that both covers and protects the eye as well as being part of the focussing function.

The cornea is made up of five individual layers which can all be subject to a variety of inflammations. In the case of Thygeson’s disease it’s the front layer – the epithelial layer – that is subject to the keratitis.

Phillips Thygeson first brought the disease to the attention of ophthalmologists in 1950 from work on his case studies. He defined it as a keratitis where the bouts of inflammation come and go and identified small lesions (punctures, cuts or grazes) on the surface made up of lots of tiny grey coloured dots, together giving a slightly cloudy appearance.

The disease now has been given the official medical name of “Thysgeson’s Superficial Punctate Keratitis” or TSPK.

Although bouts last from several days to a few weeks, returning again within weeks or months, the disease is chronic in that it can last for anything upwards of thirty years. In between bouts the eyes are fortunately normal.

What are the symptoms?

Symptoms are consistent with those for any keratitis:

•    Dry and excessively watering eyes at varied times

•    Sensitivity to light and glare

•    Blurred vision

•    The feeling of dirt or grit being in the eye

These symptoms in themselves cannot diagnose TSPK and a slit lamp test is required to provide confirmation by presence of the lesions and minute punctures. Whilst the lesions can cover the whole cornea, generally they seem to be concentrated around the central area.

Who gets it?

The disease is not infectious and quite rare; there is no information on whether or not gender, race or geographic location has any anything to do with it.

Causes of the disease are also somewhat vague, with various viral agents being considered, including the herpes simplex virus, but research is not conclusive.

It’s thought that TSPK might be associated with a variety of actions and conditions:

•    Injuries due to arc welding overuse of lamps

•    Exposure to chemicals

•    Reactions to drugs prescribed for unrelated disorders

•    Immune or allergic reaction


Eye drops used to act as artificial tears help lubricate the eye and prevent any bumps on the epithelial surface from causing pain and discomfort

Both antiviral and antibiotic medications have proven to be of little use.

Corticosteroids are often prescribed, but careful management of those drugs needs to be carried out in case they prolong the overall chronic nature of the disease. The fact that some immediate relief is obtained from corticosteroid use is indicative that an auto-immune deficiency of some kind is at work.

Soft contact lenses have been found to provide long term relief by comforting the punctures during blinking, but care and discipline with hygiene is essential, otherwise an alternative keratitis – microbial keratitis – may develop.

Refractive and laser surgery has been used to alleviate symptoms but there is little information available on success or otherwise.

About the Author

Dr Jim Kokkinakis (Optometrist) graduated in 1983 from the Optometry School University of NSW. He is currently a Senior Lecturer there and regular speaker to both Optometrists and Ophthalmologists in Australia and Internationally. He has a specialist clinical practice in the Sydney CBD with interests in Eye Strain, Computer Vision problems, Treatment of Eye Diseases and complex Contact lens Fittings.

Comments (4)

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  1. Kirk Mason says:

    Thygeson’s SPK – Personal Success Story

    I would like to describe a few steps that I take to significantly reduce my Thygeson symptoms. What I describe here has been very successful for me. Hopefully it works for others too. I just want to share this because I would have loved to have read something like this during the years I was trying to find a way to manage my Thygeson’s.

    I have had Thygeson’s keratitis for many years. It used to flare up once or twice a year, and I would go to my eye doctor to get a steroid drop prescription. After a couple weeks of mild steroid drop use per my doctor’s directions my symptoms would go away. Upon the next flare-up I would repeat the cycle.

    I never liked the idea of using the steroid drops because supposedly they increase one’s risk of developing glaucoma and other eye issues. A couple years ago my flare-ups became more frequent. Instead of having to go on drops once or twice a year, I was having symptoms every two or three months! Using the steroid drops this often made me very uneasy.

    Thankfully, I finally figured out a combination of precautionary measures that I can take to keep my eyes from flaring up. Since adopting these 3 steps over a year ago, I have not had a single flare-up. After years of testing out various hypotheses about what was causing my flare-ups, I finally developed these three rules for myself:

    (1) No caffeine
    (2) 7 or 8 hours of sleep per night
    (3) Use over-the-counter lubricating eye drops

    Regarding Points 1 and 2: Years ago, I thought stress and lack of sleep were the primary causes of my reoccurrences. I thought if I just got enough sleep and remembered to stay calm I could avoid flare-ups. But as I mentioned above, a couple years ago my flare-ups started increasing in frequency, sometimes even after periods of good sleep and low anxiety. I was beginning to despair. Then something donned on me. I realized I had been drinking more coffee that year. Originally I thought that primarily lack of sleep and extra stress were causing my Thygeson’s symptoms to worsen. But one day it struck me that less sleep meant I was drinking more coffee. I thought about my last few eye flare-ups and remembered they all came after periods of increased caffeine consumption. I hadn’t been particularly under-slept during some of those periods, but I had been drinking coffee more frequently.

    So about a year ago I cut out caffeine completely. No coffee, no tea. And I haven’t had a flare-up since. Cutting coffee may sound difficult, but it’s a price I’m glad to pay to avoid the agonizing pain of a Thygeson’s flare-up.

    And to be on the safe side I still try to get enough sleep and remember to breathe when I’m feeling stressed.

    Regarding Point 3: If I suspect even the slightest hint of irritation or even the smallest grainy sensation in my eyes I start using over-the-counter lubricating eye drops a couple times a day for a few days. I prefer to use “dry eye therapy” by the brand Thera Tears. I’m sure there are other brands that work too. Even when my eyes feel completely fine, I still use these drops every other night or so. I have also had one or two near-flare-ups, and in those instances I use these drops several times a day for a couple days. It really seems to work.

    So by following my three rules, I have been fortunate enough to avoid another flare-up. (1) NO CAFFEINE, (2) GET A FULL NIGHT’S SLEEP, (3) USE OVER-THE-COUNTER EYE DROPS.

    Hopefully this helps others out there like me. Let me know if it works for others. I would love to compile more anecdotal evidence about my personal symptom prevention protocol.

    • admin says:

      Kirk thank you for sharing your story. I would be interested if others have success using your tactics. Thygesons SPK is tricky to treat and normally is treated with topical steroids which in the long term are better to be used infrequently.

  2. G Part says:

    Interesting. I’m going through this at present, and do drink quite a lot of coffee. I think i’m going to have to give it a miss after reading this. I do worry about the amount of steroid drops i’m pumping into my eyes every time i get a flare up.

    • Kirk Mason says:

      Hi G Part,

      Please let me know if cutting out caffeine works for you. I would love for you to not have to use steroid drops as often.

      And remember another important thing I do is to use over-the-counter lubricant eye drops if my eyes show even the slightest hint of what might be a flare-up.

      Look forward to hearing about your experience.

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