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Superficial Punctate Keratitis

by Melvin I. Roat, MD, FACS

Superficial punctate keratitis is corneal inflammation of diverse causes characterized by scattered, fine, punctate corneal epithelial loss or damage. Symptoms are redness, lacrimation, photophobia, and slightly decreased vision. Diagnosis is by slit-lamp examination. Treatment depends on the cause.

Superficial punctate keratitis is a nonspecific finding. Causes may include any of the following:

  • Viral conjunctivitis (most commonly adenovirus)

  • Blepharitis

  • Keratoconjunctivitis sicca

  • Trachoma

  • Chemical burns

  • Ultraviolet (UV) light exposure (eg, welding arcs, sunlamps, snow glare)

  • Contact lens overwear

  • Systemic drugs (eg, adenine arabinoside)

  • Topical drug or preservative toxicity

  • Peripheral facial nerve palsy (including Bell palsy)

Symptoms include photophobia, foreign body sensation, lacrimation, redness, and slightly decreased vision. Slit-lamp or ophthalmoscope examination of the cornea reveals a characteristic hazy appearance with multiple punctate speckles that stain with fluorescein. With viral conjunctivitis, preauricular adenopathy is common and chemosis may occur.

Keratitis that accompanies adenovirus conjunctivitis resolves spontaneously in about 3 wk. Blepharitis (see Blepharitis), keratoconjunctivitis sicca (see Keratoconjunctivitis Sicca), and trachoma (see Trachoma) require specific therapy. When caused by overwearing contact lenses, keratitis is treated with discontinuation of the contact lens and an antibiotic ointment (eg, ciprofloxacin 0.3% qid), but the eye is not patched because serious infection may result. Contact lens wearers with superficial punctate keratitis should be examined the next day. Suspected causative topical drugs (active ingredient or preservative) should be stopped.

Ultraviolet keratitis

UVB light (wavelength < 300 nm) can burn the cornea, causing keratitis or keratoconjunctivitis. Arc welding is a common cause; even a brief, unprotected glance at a welding arc may result in a burn. Other causes include high-voltage electric sparks, artificial sun lamps, and sunlight reflected off snow at high altitudes. UV radiation increases 4 to 6% for every 1000-ft (305-m) increase in altitude above sea level, and snow reflects 85% of UVB.

Symptoms are usually not apparent for 8 to 12 h after exposure and last 24 to 48 h. Patients have lacrimation, pain, redness, swollen eyelids, photophobia, headache, foreign body sensation, and decreased vision. Permanent vision loss is very rare.

Diagnosis is by history, presence of superficial punctate keratitis, and absence of a foreign body or infection.

Treatment consists of an antibiotic ointment (eg, bacitracin or gentamicin 0.3% ointment q 8 h) and occasionally a short-acting cycloplegic drug (eg, cyclopentolate 1% drop q 4 h). Severe pain may require systemic analgesics. The corneal surface regenerates spontaneously in 24 to 48 h. The eye should be rechecked in 24 h. Dark glasses or welder’s helmets that block UV light are preventive.

Drugs Mentioned In This Article

  • Drug Name
    Select Trade
  • CILOXAN, CIPRO
  • GENOPTIC
  • BACIIM
  • AKPENTOLATE, CYCLOGYL

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