superficial punctate keratitis
Introduction
Introduction to superficial punctate keratitis Shallow punctate keratitis is a general term for three types of lesions of the corneal epithelium, namely, punctate epithelial keratitis, punctate epithelial erosion and punctate subepithelial infiltration. They often exist at the same time, but the weight and extent of the lesion are biased and different. Clinically manifested as photophobia, tingling, acid grinding, blurred vision or fog. In various bacterial conjunctivitis or blepharitis, epithelial erosion and punctate superficial inflammation of the cornea and subepithelial infiltration at the margins of multiple membranes are often present. These lesions are sometimes scattered on the cornea, sometimes diffuse throughout the cornea. Distribution, especially in the peripheral part of the cornea. Preventing keratitis and eating some foods that contain vitamin A are also good for the eyes. When keratitis is deficient in vitamin A, the ability of the eyes to adapt to the dark environment is diminished, and in severe cases, it is prone to night blindness. Eating enough vitamin A every day can also prevent and treat dry eye. The best source of vitamin A is the liver of various animals, while plant foods such as carrots, leeks, spinach, etc. basic knowledge Sickness ratio: 0.01%-0.02% Susceptible people: no specific population Mode of infection: non-infectious Complications: dry eye blepharitis
Cause
Causes of superficial punctate keratitis
Bacterial infection (25%):
In various bacterial conjunctivitis or blepharitis, epithelial erosion and punctate superficial inflammation of the cornea and subepithelial infiltration at the margins of multiple membranes are often present. These lesions are sometimes scattered on the cornea, sometimes diffuse throughout the cornea. Distribution, especially in the peripheral part of the cornea.
Viral infection, potion stimulation (30%):
In the early stages of various viral conjunctivitis, it is often possible to cause corneal punctate epithelial erosion first. Frequent eye irritation or UV stimulation can cause corneal epithelial erosion and inflammation.
Other (18%):
Mechanical stimulation can cause epithelial abrasions, trichiasis and malnutrition can lead to epithelial erosion and inflammation. Other eye diseases, such as dry keratitis, spring conjunctivitis, and drug allergy can cause damage to the corneal epithelium.
Prevention
Shallow punctate keratitis prevention
1. Non-contact lens wearer's superficial punctate keratitis does not need to be referred to by simple SPK, except for children or patients with poor treatment compliance. If SPK is caused by primary eye disease, the follow-up principle is the same as primary eye disease.
2. The moderate to severe superficial punctate keratitis of the contact lens wearer should be reviewed daily until there is a significant improvement.
Complication
Shallow punctate keratitis complications Complications dry eye blepharitis
Shallow punctate keratitis is non-specific and is common in the following diseases: dry eye, blepharitis, exposed keratopathy, orbital skin relaxation syndrome.
Symptom
Shallow punctate keratitis symptoms common symptoms red eye tears ciliary congestion fog vision film inflammation photophobia corneal erosion eyelids
Shallow punctate keratitis is clinically common and its characteristics are different. The diagnostic basis is now divided as follows:
1. Staphylococcal keratitis: often associated with chronic conjunctivitis, concentrated in the lower third of the cornea, which is a point-like spur of the tip of the needle, showing a very fine point, an infiltrating lesion with an ellipse or a circle above the epithelium. .
2, red eye keratitis: mostly in the pupillary corneal epithelium or epithelial punctate infiltration, uneven size.
3, monosporous epithelial keratitis: epithelial point and linear infiltration quickly developed into a tree-like shape.
4, spring conjunctival inflammatory keratitis: mostly in the spring conjunctivitis, dotted line epithelial stripping on the entire cornea.
5, trachoma keratitis: located at the upper end of the cornea, the end of the vasospasm of the trachoma and epithelial infiltration, erosion and shallow ulcers.
6, surface punctate keratitis: fluorescein staining in the corneal pupil area has a focus-like tip size fine dot on the table coloring.
7, drug-induced corneal dermatitis: evenly distributed on the entire surface of the cornea fine point turbidity, useful point of eye history.
8, radiation keratitis: more common in elated ophthalmitis, ciliary congestion, eyelids, tears and other symptoms, diffuse exfoliation of the corneal epithelium in the cleft palate.
(a) Conscious symptoms
Photophobia, tingling, sour grinding, blurred vision or fog.
(two) signs
1, punctate epithelial keratitis
Signs vary according to their etiology.
(1) simple catarrhal keratitis: more common in the elderly, needle-like gray-white infiltration along the limbus, or light yellow bead-like infiltration, the disease can be further developed to form a crescent-shaped shallow ulcer with parallel limbus.
(2) viral punctate keratitis: due to viral infection of the corneal epithelial layer or subcutaneous epithelial opacity infiltration, adenovirus is more common, such as adenovirus type 8 caused by epidemic keratoconjunctivitis, epidemic bleeding caused by enterovirus Conjunctivitis, often caused by monocular or binocular involvement, conjunctival hyperemia, mild edema, after 1 to 2 weeks, after conjunctivitis subsided, can cause inflammation and infiltration in the corneal epithelium and epithelium in the pupil area, visible Dot-like fine gray dots of varying thickness or stellate line-like turbidity, fluorescein staining can be colored. After 2 to 3 days, these point-like infiltrates become flat and quickly become dendritic or map-like infiltration. , merged into a group.
(3) superficial punctate keratitis: manifested as inflammation of the corneal epithelial tip of both eyes, but no epithelial infiltration, light and heavy, lasting for several months, observed under high-fissure microscopy, the point-like coloration is elliptical, slightly high With the epithelial surface, this keratitis does not leave scars after healing.
2, the following infiltration on the dot
(1) Trachomatous subepithelial invasive keratitis: at the end of the trachoma vasospasm above the cornea, there is a thick, superficial stromal ulcer, which often leaves thin or plaque after healing.
(2) money keratitis: in the epithelium of the cornea pupil area, such as coin-like infiltration, the size varies, slit lamp examination, the infiltration is mostly in the superficial stromal layer, often leaving scar after healing.
3, punctate epithelial erosion
(1) Single or multiple punctate epithelial defects, the defect area is transparent, and the corneal epithelial edema around it is not easy to find under the direct sulcus, and the eye has repeated attacks, often with eyelids and ciliary congestion.
(2) In the early cases of superficial corneal dystrophy after traumatic or chemical debridement, periodic punctate epithelial erosion often occurs. After these defects are repaired, the epithelium often has fingerprints or vortex turbidity.
Examine
Examination of superficial punctate keratitis
1. Evaluation of corneal and tear film conditions.
2. Check if the contact lens is properly worn, if there is any deposit, if the edge is sharp, and if there is any crack.
Diagnosis
Diagnosis and differential diagnosis of superficial punctate keratitis
How to identify shallow punctate keratitis:
1. The red eye keratitis is mostly located in the corneal epithelium or epithelial area of the pupillary area, and the shape is uneven.
2, staphylococcal keratitis often associated with chronic conjunctivitis, concentrated in the lower third of the cornea. It is a point-like smashed skin with a fine point, ellipse or round infiltration of the epithelium.
3, trachoma keratitis is located in the upper end of the cornea, the end of the vasospasm of the trachoma and epithelial infiltration, erosion and shallow ulcers.
4, monosporous epithelial keratitis subcutaneous point and linear infiltration quickly developed into a tree-like shape.
5, superficial punctate keratitis fluorescein staining in the corneal pupil area has a focus-like tip size fine dot on the table coloring.
