•Multiple, small discrete lesions of the cornea - Affect epithelial and subepithelial layers
Causes based on distribution of lesions in the cornea:
•Generalized - Acute conjunctivitis, Toxic conjunctivitis, Vernal conjunctivitis
•Central- Adenoviral conjunctivitis, Thygeson’s, CL overwear
•Upper ⅓ - Inclusion Conjunctivitis, Superior limbic Keratoconjunctivitis
•Lower ⅓ - Staphylococcus disease, Exposure keratitis, Entropion
•Lower ⅔- Dry eye, Exposure keratitis, Neurotrophic keratitis
•Zonular- Herpes
•Paralimbal- Adjacent to pterygium/ any other conjunctival lesion
•Linear streak- Tarsal foreign body
Types:
•Superficial punctate epithelial erosions - Slightly depressed spots - visible only after staining with fluorescein
•Superficial punctate epithelial keratitis- Greyish white opacities - visible without fluorescein staining, stains poorly with fluorescein and stain well with rose bengal
•Combined epithelial and subepithelial punctate keratitis
SYMPTOMS:
•Foreign body sensation.
•Tearing.
•Decreasing vision if central cornea affected.
SIGNS:
•Multiple, tiny, pinpoint epithelial defects that stain well with fluorescein.
Look for associated ocular changes:
1. Conjunctival changes
2. Eyelid lesions
3. Limbal changes
4. Abnormal tear function
5. Discharge
TREATMENT:
•Treat underlying disorder.
•Discontinue toxic medications and contact lens wear.
•Preservative- free lubricating eye drops/gel/ointment.
•Topical prophylactic antibiotics.
www.ophthalmobytes.com
Image from Rajan Eye Care Hospital
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