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Superficial Punctate Keratitis


Melvin I. Roat

, MD, FACS, Sidney Kimmel Medical College at Thomas Jefferson University

Last full review/revision May 2020| Content last modified May 2020
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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:

Keratitis that accompanies adenovirus conjunctivitis resolves spontaneously in about 3 weeks. Blepharitis Blepharitis Blepharitis is inflammation of the eyelid margins that may be acute or chronic. Symptoms and signs include itching and burning of the eyelid margins with redness and edema. Diagnosis is by history... read more Blepharitis , keratoconjunctivitis sicca Keratoconjunctivitis Sicca Keratoconjunctivitis sicca is chronic, bilateral desiccation of the conjunctiva and cornea due to an inadequate tear film. Symptoms include itching, burning, irritation, and photophobia. Diagnosis... read more Keratoconjunctivitis Sicca , and trachoma Trachoma Trachoma is a chronic conjunctivitis caused by Chlamydia trachomatis and is characterized by progressive exacerbations and remissions. It is the leading cause of preventable blindness worldwide... read more 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% four times a day), 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

Ultraviolet (UV) B 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 hours after exposure and last 24 to 48 hours. 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 every 8 hours) and occasionally a short-acting cycloplegic drug (eg, cyclopentolate 1% drop every 4 hours). Severe pain may require systemic analgesics (eg, acetaminophen 500 mg every 4 hours for 24 hours). The corneal surface regenerates spontaneously in 24 to 48 hours. The eye should be rechecked in 24 hours. Dark glasses or welder’s helmets that block UV light are preventive.

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