A Case of Supratarsal Injection of Triamcinolone in Management of Chronic Thygeson's Superficial Punctate Keratitis

PURPOSE: To report a case of supratarsal injection of triamcinolone for the management of chronic, steroid-dependent Thygeson's superficial punctate keratitis. CASE SUMMARY: A 37-years-old woman complained of redness, photophobia, and tearing in both eyes, which lasted for 6 years. The slit lamp examination revealed multiple intraepithelial and subepithelial, punctated corneal lesions which were elevated and scattered diffusely upon staining with fluorescein dye in both eyes. The patient was diagnosed with Thygeson's superficial punctate keratitis and treated with 0.1% fluorometholone, 0.05% cyclosporin, and 0.15% ganciclovir in both eyes. After 10 months of follow-up, recurrences were reported twice in the right eye, and 7 times in the left eye. The patient was treated with a supratarsal injection of triamcilonone in both eyes and after injection, the patient was treated only with artificial tears. Four months later, the patient did not complain of any symptoms and her cornea was clear. CONCLUSIONS: A supratarsal injection of triamcinolone may be an effective method to prevent recurrence of chronic, steroid-dependent Thygeson's superficial punctate keratitis.

The Short-Term Effect of Topical Cyclosporine A 0.05% in Various Ocular Surface Disorder

PURPOSE: To evaluate the efficacy of topical cyclosporine A 0.05% (Restasis) in the treatment of dry eye symptoms caused by various ocular surface inflammatory disorders. METHODS: Thirty three patients with ocular surface diseases, including 17 with Sjogren syndrome, 8 with meibomian gland dysfunction (MGD), 4 with Thygeson's keratitis, and 4 with atopic keratoconjunctivitis (AKC) were treated with Restasis twice a day for 3 months. During follow up, the symptom severity assessment (burning, itching, foreign body sensation, blurring, photophobia, and pain), TBUT (tear break up time), Schirmer score, frequencies of artificial tear use, onset of symptomatic relief, subjective satisfaction score, and side effects were evaluated. RESULTS: In patients with Sjogren syndrome, foreign body sensation, blurring, photophobia, and pain were reduced after treatment, and the mean Schirmer score, TBUT increased and frequencies of artificial tear use decreased significantly. In patients with MGD, photophobia was reduced after treatment, TBUT and artificial tear use improved after 2 months, and the Schirmer score increased at 3 months. In patient's with Thygeson's keratitis, foreign body sensation and photophobia reduced, and the Schirmer score was increased at 3 months. No significant changes in symptoms, Schirmer score, or TBUT were observed in patients with AKC. Of all subjects, 55% reported symptomatic relief between 3 and 5 weeks after treatment. The mean satisfaction score after treatment was the highest for patients with Sjogren syndrome. Two subjects reported a temporary burning sensation, and one subject quit using Restasis because of bitter taste and a burning sensation. CONCLUSIONS: Treatment with Restasis appeared to be effective in treating dry eye symptoms in patients with Sjogren syndrome. It was shown to be partially helpful in patients with MGD and Thygeson's keratitis, while it showed no beneficial effect in patients with AKC.