Punctate keratitis

Ocular complications following local or systemic administration of steroids include glaucoma, cataracts, adverse influence on specific ocular infections, pseudotumor cerebri, ptosis, mydriasis, subjective visual complaints, visual field defects, systemic absorption of the topical medication, conjunctival and palpebral petechiae, epithelial punctate keratitis, and, possibly, corneal and scleromalacia. ... 

Primary axillary hyperhidrosis Adverse events (in at least 3% of patients) included injection site pain and hemorrhage, nonaxillary sweating, infection, pharyngitis, flu syndrome, headache, fever, neck or back pain, pruritus, and anxiety. Blepharospasm The most frequently reported treatment-related adverse reactions were ptosis (20.8%), superficial punctate keratitis (6.3%), and eye dryness (6.3%). Strabismus Extraocular muscles adjacent to the injection site can be affected, causing ptosis, vertical deviation, spatial disorientation, double vision, or past-pointing, especially with higher doses of botulinum toxin type A. 

Ophthalmic - Bimatoprost-associated ocular adverse events that occurred in 3% to 10% of patients, in descending order of incidence, included the following Ocular dryness, visual disturbances, ocular burning, foreign body sensation, eye pain, pigmentation of the periocular skin, blepharitis, cataract, superficial punctate keratitis, eyelid erythema, ocular irritation, eyelash darkening. 

Inflammatory conditions Treatment of steroid-responsive inflammatory conditions of the palpebral and bulbar conjunctiva, lid, sclera, cornea, and anterior segment of the globe, such as Allergic conjunctivitis acne rosacea superficial punctate keratitis herpes zoster keratitis iritis cyclitis and selected infective conjunctivitis (when the inherent hazard of steroid use is accepted to obtain an advisable diminution in edema and inflammation [prednisolone]) vernal conjunctivitis episcleritis epinephrine sensitivity and anterior uveitis. 

Corneal edema, eye discharge, eye irritation, eye pain, increased intraocular pressure, ocular discomfort, punctate keratitis, reduced visual acuity, visual disturbance, vitreous floater, vitreous opacities... 

Dorzolamide (Trusopt) [Carbonic Anhydrase Inhibitor, Sul fonamide/Glaucoma Agent] Uses Glaucoma Action Carbonic anhydrase inhibitor Dose 1 gtt in eye(s) tid Caution [C, ] Contra Component sensitivity Disp Soln SE Irritation, bitter taste, punctate keratitis, ocular allergic Rxn EMS T Effects W/ oral carbonic anhydrase inhibitors, salicylates EMS Drug is absorbed systemically OD May cause electrolyte disturbances (K) and acidosis monitor ECG... 

Ophthalmic Dry eyes, acute angle closure glaucoma, punctate keratitis, visual disturbance... 

In some patients, especially those over age 50 years, a localized or diffuse desquamation of corneal epithelium becomes evident (figure 6-3). This epithelial reaction usually consists of superficial punctate keratitis and probably results from exposure and tear film instability associated with decreased reflex tearing, infrequent blinking, and increased tear evaporation. The punctate keratopathy is frequently absent immediately after anesthetic instillation but may appear 5 to 30 minutes later (Figure 6-4). 

Toxic keratitis has also been reported after abuse of cyclopentolate. Instillation of 100 to 400 drops of the 1% solution over several months caused a diffuse epithelial punctate keratitis with marked conjunctival hyperemia. As expected, the pupils were widely dilated and unresponsive to light. 

Dorzolamide is generally well tolerated. Ocular side effects include local irritation, possibly related to pH and tonicity. Stinging (7%), burning or foreign body sensation (12%), and blurring of vision (9%) are among the most common. Others include superficial punctate keratitis and headache. A severe sterile purulent conjunctivitis developing over weeks to months was described in seven patients and resolved on discontinuation of dorzolamide. Because all CAIs are sulfonamides, local sensitization has... 

Nesbum AB, Lowe GH, Lapoff bjj, et al. Effect of topical trifluri-dine on Thygeson s superficial punctate keratitis. Ophthalmology 1984 91(10) 1188-1192. 

Immune reaction after keratoplasty Herpes zoster keratitis Disciform keratitis Marginal corneal infiltrates Superficial punctate keratitis Chemical burns Acne rosacea keratitis Interstitial keratitis Uvea... 

Topical CsA (2%) is a beneficial therapy for symptomatic treatment ofThygeson s superficial punctate keratitis. Topical corticosteroids are generally the first line of treatment. Secondary therapy includes extended-wear contact lenses and CsA. CsA, however, has been shown to be beneficial when used as the primary treatment. In one study long-term use of 2% topical CsA in olive oil (four times a day for 3 months followed by twice daily treatment for 1 month) was evaluated in eight Thygeson s ... 

Nagra PK, Rapuano CJ, Cohen EJ, Laibson PR.Thygeson s superficial punctate keratitis ten years experience. Ophthalmology 2004 111 34-37. 

ReinhardT, Srmdmacher R.Topical cyclosporine A inThygeson s superficial punctate keratitis. Graefe s Arch CUn Exp Ophthalmol 1999 237 109-112. 

Associated conditions may include papillary conjunctivitis keratoconjunctivitis sicca (KGS), present in as many as 50% of patients superficial punctate keratitis (SPK), affecting predominantly the inferior quadrant of the cornea ... 

Both conditions can cause a wide range of symptoms, the most common a foreign body sensation and a red irritated eye. Severe or debilitating symptomatology is a result of corneal surface damage, including corneal abrasion and superficial punctate keratitis. Corneal hypoesthesia with subsequent neurotrophic ulceration is also possible. 

Epidemic keratoconjunctivitis Pharyngoconjunctival fever Any age Predominandy children Follicles, hyperemic membranes Follicles, hyperemic membranes Subepithelial infiltrates common Superficial punctate keratitis subepithelial infiltrates not common Tender, palpable preauricular node Fever, pharyngitis, nontender node Adenovirus types 8 and 19 Adenovirus types 3 and 7... 

Eite SW, Chodosh J. Photorefractive keratectomy for myopia in the setting of Thygeson s superficial punctate keratitis. Cornea 2001 20 425-426. [Comment in Cornea 2001 20 904 Cornea 2002 21 736-737 author reply 737.]... 

Netto MV, ChaUta MR, Krueger RR.Thygeson s superficial punctate keratitis recurrence after laser in situ keratomileusis. AmJ Ophthalmol 2004 138 507-508. 

Reinhard T, Roggendorf M, Eengler I, et al. PCR for varicella zoster virus genome negative in comeal epithelial cells of patients with Thygeson s superficial punctate keratitis. Eye 2004 18 304-305. 

AM = morning CL = contact lens Conj = conjunctival D/C = discontinue RGP = rigid gas permeable SPK = superficial punctate keratitis. FromAUansmith MR, Korb DR, Greiner jy et al. Giant papillary conjunctivitis in contact lens wearers.Am J Ophthalmol 1977 83 700. 

Isotretinoin (also see text Drugs Corneal opacities, superficial punctate keratitis, neovascularization... 

Dry eye symptoms and significant ocular surface disease frequently occur in patients taking isotretinoin.The associated symptoms may be accompanied by blepharocon-jimctivitis. The presence of isotretinoin in tear fluid decreases stability (and tear break-up time) of the lipid layer of the tear film but may also cause a decrease in aqueous production, leading to ocular surface dryness. These effects could be responsible for the dry eye symptoms, contact lens intolerance, superficial punctate keratitis, and conjunctival irritation accompanying isotretinoin therapy. Use of artificial tear preparations may help to alleviate the associated discomfort. 

Niacin has been used for its triglyceride and cholesterollowering effects, but a certain association has been made to cystoid macular edema. Blurred vision is considered probable with this agent. Other associations include dry eyes, discoloration of the eyelids, eyelid edema, loss of brow and lash hair, and superficial punctate keratitis. 

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