Thygesonic Keratitis

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Classification according to ICD-10
H16.1 Other superficial keratitis without conjunctivitis
Superficial keratitis punctata
ICD-10 online (WHO version 2019)

The rare Thygeson keratitis (also: keratitis superficialis punctata type Fuchs-Thygeson ) is a chronic eye disease that often occurs on both sides , with punctiform defects and infiltrates ( keratitis superficialis punctata ) of the outer corneal layer ( epithelium ). The changes appear in a rounded, star-shaped or oval shape, disappear again, reappear and can change more frequently in type and number. The clinical picture is named after the American doctor Phillips Thygeson (* 1903), who first described it in this form in 1950.

Symptoms

Punctiform corneal defects in Thygeson's keratitis

Affected patients are often people under 40 years of age. They complain of a slight foreign body sensation and, depending on the location of the opacities, possibly a slight deterioration in visual acuity . Increased tearing , burning, itching, and photophobia are also typical. The course can last for months or even years, but is usually self-healing. During the illness, there are often worsening findings ( exacerbations ) or slight improvements, but without complete healing ( remissions ).

The inflammation is limited to the cornea. The conjunctiva or other eye structures are typically not affected. In this respect, Thygeson's keratitis must be differentiated from other forms of superficial punctate keratitis.

root cause

The cause of the disease is unclear and is controversial. A viral infection ( herpes zoster virus) or a chlamydial infection was suspected especially in the past . There is evidence of a genetic association with HLA-DR3 , an immune antigen.

therapy

Unpreserved tear substitutes ( artificial tears ) are recommended. If it is unsuccessful, eye drops containing cortisone can also be used. An alternative to this is locally applied cyclosporine A, which is said to cause fewer side effects and recurrences than corticosteroids . According to a study at the end of the 1990s, the typical clinical symptoms of Thygeson's keratitis regressed in over 70% of the patients treated in this way . In general, the long-term prognosis is considered good.

Individual evidence

  1. ^ German Ophthalmological Society (DOG): Register of rare diseases
  2. ^ Phillips Thygeson: Superficial punctate keratitis. In: J Am Med Assoc. 1950; 144, pp. 1544-1549. PMID 14794375 .
  3. ↑ Paul P Connell, James O'Reilly, Suzie Coughlan, Louis MT Collum, William J Power: The role of common viral ocular pathogens in Thygeson's superficial punctate keratitis . In: Br J Ophthalmol . tape 91 , no. 8 , 2007, p. 1038-1041 , PMC 1954834 (free full text).
  4. ↑ RS Duszak: Diagnosis and management of Thygeson's superficial punctate keratitis . In: Optometry . tape 78 , no. 7 , 2007, p. 333-338 , PMID 17601570 .
  5. ^ RW Darrell: Thygeson's superficial punctate keratitis: natural history and association with HLA DR3 . In: Trans Am Ophthalmol Soc . tape 79 , 1981, pp. 486-516 , PMC 1312196 (free full text).
  6. ↑ Bartosz Wojanowski: Safety of local cyclosporine A in inflammatory diseases of the cornea and conjunctiva . In: Dissertation from the eye clinic of the Heinrich Heine University in Düsseldorf . 2007.

literature

  • Albert J. Augustin: Ophthalmology. 3. Edition. Springer, 2007, ISBN 978-3-540-30454-8 , p. 253.
  • H. Pau (Ed.): Textbook and Atlas of Ophthalmology . Gustav Fischer Verlag, Stuttgart 1980, ISBN 3-437-00255-4 , p. 229 ff.