bubble_chart Overview

Superficial punctate keratopathy is a collective term for three types of corneal epithelial lesions: punctate epithelial keratitis, punctate epithelial erosions, and punctate subepithelial infiltrates. These conditions often coexist, differing mainly in severity and the extent of the lesions.

bubble_chart Etiology

1. Bacterial infection: In various bacterial conjunctivitis or blepharitis, it is often accompanied by epithelial erosion and punctate superficial inflammation of the cornea, as well as subepithelial infiltration at the corneal margin. These lesions are sometimes scattered on the cornea and sometimes diffusely distributed over the entire cornea, especially more in the peripheral part of the cornea.

2. Viral infection: In the early stages of various viral conjunctivitis, it may first cause punctate epithelial erosion of the cornea.

3. Frequent stimulation from eye drops or ultraviolet light can cause corneal epithelial erosion and inflammation.

4. Mechanical irritation can cause epithelial abrasions, and trichiasis as well as malnutrition can lead to epithelial erosion and inflammation.

5. Other eye diseases, such as dry keratitis, vernal conjunctivitis, and drug allergies, can also cause damage to the corneal epithelium.

bubble_chart Clinical Manifestations

(1) Subjective Symptoms

Photophobia, stinging pain, soreness, blurred vision, or foggy vision.

(2) Signs

1. Punctate epithelial keratitis: Signs vary depending on the cause of the disease.

(1) Simple catarrhal keratitis: Commonly seen in the elderly. Needle-like gray-white infiltrates or light yellow bead-like infiltrates occur along the corneal margin. Further progression of the condition can lead to the formation of a crescent-shaped superficial ulcer parallel to the corneal margin.

(2) Viral punctate keratitis: Caused by viral infection of the corneal epithelium or subepithelial punctate opacities and infiltrates, often associated with adenoviruses, such as adenovirus type 8 causing epidemic keratoconjunctivitis, or enteroviruses causing epidemic hemorrhagic conjunctivitis, often affecting one or both eyes. The bulbar conjunctiva shows mixed congestion and grade I edema. After 1-2 weeks, as the conjunctivitis subsides, inflammation and infiltrates can occur in the corneal epithelium and subepithelial layer in the pupillary area, presenting as varying sizes of small gray punctate spots or stellate linear opacities, which can be stained with fluorescein. After 2-3 days, these punctate infiltrates flatten and quickly transform into dendritic or geographic infiltrates, merging into clusters.

(3) Superficial punctate keratitis: Presents as pinhead-sized inflammation in the corneal epithelium of both eyes, but without subepithelial infiltrates. The condition fluctuates in severity and can persist for months or years. Under high-power slit-lamp microscopy, the punctate staining appears oval and slightly elevated above the epithelial surface. This type of keratitis heals without scarring.

2. Subepithelial infiltrates

(1) Trachomatous subepithelial infiltrative keratitis: At the end of the trachomatous vascular nebula above the cornea, there are coarse punctate superficial stromal ulcers, which often leave a thin nebula or patchy nebula after healing.

(2) Numular keratitis: Coin-shaped infiltrates of varying sizes appear in the subepithelial layer of the corneal pupillary area. Slit-lamp examination reveals that the infiltrates are mostly in the superficial stromal layer, often leaving scars after healing.

3. Punctate epithelial erosions

(1) Single or multiple punctate epithelial defects, with the defect area being transparent and surrounding corneal edema. These are difficult to detect under direct slit-lamp illumination. The affected eye often experiences recurrent episodes, accompanied by eyelid spasms and ciliary congestion.

(2) Periodic punctate epithelial erosions often occur in early cases of traumatic or chemical debridement-induced superficial corneal dystrophy. After the erosions heal, the epithelium often retains fingerprint-like or vortex-like opacities.

bubble_chart Diagnosis

Superficial punctate keratitis is relatively common in clinical practice and its characteristics vary. The diagnostic criteria are divided as follows:

1. Staphylococcal keratitis: Often associated with chronic conjunctivitis, concentrated in the lower 1/3 of the cornea. It presents as pinpoint-sized erosions, appearing as very fine punctate, oval, or round infiltrative lesions raised above the epithelium.

2. Red eye keratitis: Mostly located in the corneal epithelium or subepithelium of the pupillary area, showing punctate infiltration of uneven size.

3. Herpetic epithelial keratitis: Subepithelial punctate and linear infiltrations quickly develop into dendritic patterns.

4. Vernal conjunctivitis keratitis: Mostly occurs with vernal conjunctivitis, with punctate and linear epithelial erosions scattered across the entire cornea.

5. Prickly-ash-like sore (trachoma) keratitis: Located at the upper end of the cornea, with epithelial and subepithelial infiltration, erosion, and shallow ulcers at the end of the prickly-ash-like sore (trachoma) vascular nebula.

6. Superficial punctate keratitis: Fluorescein staining shows pinpoint-sized focal staining in the pupillary area of the cornea.

7. Drug-induced corneal epithelitis: Uniformly distributed fine punctate opacities across the entire corneal surface, with a history of topical medication use.

8. Radiation keratitis: Commonly seen in electric ophthalmia, with symptoms such as ciliary congestion, eyelid spasm, and tearing. Diffuse patchy epithelial erosions are observed in the corneal area exposed by the palpebral fissure.

bubble_chart Treatment Measures

1. Etiological treatment: Adopt corresponding treatment based on the disease cause.

2. Antibiotic and antiviral eye drops.

3. Microdose corticosteroid eye drops or combined with other antibiotic eye drops.