View Full Version : Superficial Punctate Keratopathy

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07-13-2013, 04:53 PM
Pain, photophobia, red eye, foreign body sensation, mildly decreased vision.

Critical. Pinpoint corneal epithelial defects (stain with fluorescein); may be confluent if severe. Pain is relieved by the instillation of anesthetic drops.
Relief of pain with the instillation of anesthetic drops (e.g., proparacaine) strongly suggests corneal epithelial disease as the etiology of pain. Although anesthetic drop instillation is an essential part of the ocular examination, patients should NEVER be prescribed topical anesthetic drops and the clinician should ensure the patient does not take anesthetic drops from the office. When used chronically, these drops inhibit epithelial healing and cause ring corneal ulcers.
Other. Conjunctival injection, watery discharge.

Superficial punctate keratopathy (SPK) is nonspecific but is most commonly seen with the following disorders:
Dry-eye syndrome: Poor tear lake, decreased tear break-up time, decreased Schirmer test. SPK in an interpalpebral location. Dry-Eye Syndrome.
Blepharitis: Erythema, telangiectasias, or crust-ing of the eyelid margins, meibomian gland dysfunction. SPKs are located inferiorly near the eyelid margin. , Blepharitis/Meibomitis.
Trauma: Can occur from relatively mild trauma, such as chronic eye rubbing.
Exposure keratopathy: Poor eyelid closure with failure of eyelids to cover the entire globe. SPKs are inferior. , Exposure Keratopathy.
Topical drug toxicity: e.g., neomycin, gentamicin, trifluridine, atropine or any drops with preservatives, including artificial tears or any frequently used drop.
Ultraviolet burn/photokeratopathy: Often in welders or from sun lamps. Thermal/ Ultraviolet Keratopathy.
Mild chemical injury: , Chemical Burn.
Contact lens–related disorder: e.g., chemical toxicity, tight lens syndrome, contact lens overwear syndrome, giant papillary conjunctivitis. , Contact Lens–Related Problems.
Thygeson SPK: Bilateral, recurrent epithelial keratitis (raised epithelial staining lesions, not SPK) without conjunctival injection. See 4.8, Thygeson Superficial Punctate Keratopathy.
Foreign body under the upper eyelid: Typi-cally linear SPK, fine epithelial defects arranged vertically.
Conjunctivitis: Discharge, conjunctival injection, eyelids stuck together on awakening. , Acute Conjunctivitis, and Chronic Conjunctivitis.

Trichiasis/distichiasis: One or more eyelashes rubbing against the cornea. Trichiasis.
Entropion or ectropion: Eyelid margin turned in or out. Area of SPK is superior or inferior. , Ectropion and Entropion.
Floppy eyelid syndrome: Extremely loose upper eyelids that evert very easily. Floppy Eyelid Syndrome.