Faculty Bibliography

PURPOSE: To evaluate the presentation, treatment, and disease course of Thygeson's superficial punctate keratitis. DESIGN: Observational case series. PARTICIPANTS: Forty patients, diagnosed and managed with Thygeson's superficial punctate keratitis between January 1, 1992, and December 31, 2001, on the Cornea Service at Wills Eye Hospital. METHODS: Retrospective chart review. MAIN OUTCOME MEASURES: Patient demographics, symptoms, visual acuity, ophthalmic examination, management, duration of disease, and length of follow-up. RESULTS: At the time of presentation, the mean patient age was 28.7 years. The most common presenting symptoms included photophobia, blurred vision, and irritation. Thirty of 38 patients without a history of decreased vision (78.9%) initially were seen with visual acuities in both eyes of 20/30 or better. The 8 (21.1%) remaining patients all had visual acuities between 20/40 and 20/50; improvement in vision with treatment was noted in all 3 observed at our institution. Six patients (16%) had unilateral disease, whereas another 2 patients had bilateral involvement develop after unilateral presentation. Thirty-nine patients (97.5%) were treated with topical steroids at some point in their disease course. The patient not managed with steroids was only seen once and was managed with artificial tears for mild symptoms. In addition to steroids, a patient was treated for recurrent episodes with extended-wear contact lens, and another patient was started on topical cyclosporine because of an inability to be tapered off topical steroids. The average duration of disease in the 15 patients who were observed for more than a single year was 11.1 years. CONCLUSIONS: Thygeson's superficial punctate keratitis is a potentially chronic condition, which might affect people of all ages for years to decades. Corticosteroids are the mainstay of treatment, with extended-wear contact lens and topical cyclosporine reserved as secondary agents

PURPOSE: To report a case series of contact lens-related corneal ulcers in compliant patients with no apparent predisposing factors. DESIGN: Retrospective case series. METHODS: Charts of 70 patients with contact lens-related corneal ulcers from July 1999 to June 2002 were reviewed. Lens care hygiene and method of disinfection, as well as frequency of lens replacement, were recorded. Only patients who followed recommended guidelines for contact lens wear were included in the study. RESULTS: Of the 70 patients, 21 (30%) developed corneal ulcers despite being compliant with the guidelines for contact lens wear. All patients used multipurpose solutions for cleaning, disinfecting, and storing daily wear soft contact lenses. CONCLUSION: Standard lens care hygiene does not seem to be sufficient in preventing the development of corneal ulcers in patients using conventional and frequent replacement daily wear soft contact lenses

PURPOSE: To report two cases of Descemet membrane detachment associated with hemorrhage after alkali burn to the cornea. DESIGN: Observational case reports. METHODS: We describe two patients with detachment of Descemet membrane associated with hemorrhage after alkali burns to the cornea. RESULTS: Patient 1 received a splash of caustic soda to the face. Descemet membrane detachment with hemorrhage was present. An attempt at reattachment using intraocular gases failed. Patient 2 sustained a chemical burn secondary to an airbag injury. A thickened, detached Descemet membrane associated with a hyphema was evident. CONCLUSIONS: Detachments of Descemet membrane associated with alkali burns are often accompanied by irreversible endothelial cell damage