What is the management approach for Superficial Punctate Keratitis (SPK)?

From the Guidelines

The management of Superficial Punctate Keratitis (SPK) should prioritize the use of preservative-free artificial tears and cyclosporine 0.05% drops twice daily to address the underlying ocular surface condition and reduce inflammation. According to the most recent consensus report by the Taiwan Society of Cataract and Refactive Surgeons 1, the treatment approach for SPK involves tear supplementation or conservation, including nonpreserved artificial tears, temporary punctal occlusion, and moisture chamber spectacles or goggles.

When considering the treatment options, the following key points should be taken into account:

• Preservative-free artificial tears are recommended for patients with poor ocular surface condition, such as severe corneal epithelial defects or SPK, and for those who frequently instill artificial tears (> 4 times/day) 1.
• Cyclosporine should be administered to patients with SPK and those with severe symptoms refractory to present medications 1.
• Topical steroids may be used for short-term relief, but their use should be cautious and under close ophthalmological supervision due to potential complications 1.
• In-office therapy for meibomian gland dysfunction, such as physical heating and expression of the meibomian glands, intense pulsed light therapy, and/or thermo pulsation therapy, may also be beneficial in managing SPK 1.

In terms of specific treatment regimens, the following may be considered:

• Preservative-free artificial tears every 2-4 hours to lubricate the ocular surface.
• Cyclosporine 0.05% drops twice daily to reduce inflammation and promote healing.
• Topical antibiotics, such as topical antibiotics or antibiotic-steroid combinations, may be applied to the lid margins for anterior blepharitis, if present 1.
• Temporary discontinuation of contact lens wear, if applicable, to prevent further irritation and promote healing.

Regular follow-up, ideally within 3-7 days, is crucial to monitor healing, adjust treatment, and prevent potential complications, such as corneal scarring and vision impairment 1.

From the Research

Management Approach for Superficial Punctate Keratitis (SPK)

The management approach for Superficial Punctate Keratitis (SPK) involves various treatment options, including:

• Topical corticosteroids: Used to reduce inflammation and prevent scarring 2
• Topical cyclosporin A: Effective in suppressing epithelial and subepithelial opacities, with some patients achieving complete healing 3, 4
• Autologous serum eye drops: May be used to promote corneal healing and reduce symptoms 5
• Cyclosporine 0.05%: Can be used to reduce total steroid exposure in patients with TSPK 6

Treatment Outcomes

Treatment outcomes for SPK vary, with some patients experiencing:

• Complete suppression of opacities with topical cyclosporin A 3, 4
• Recurrences after stopping therapy, which can be managed with topical corticosteroids or cyclosporin A 3, 4
• Significant reduction in total steroid exposure with the use of cyclosporine 0.05% 6
• Corneal scarring in some cases, particularly with prolonged disease course 2

Patient Considerations

Patient considerations for SPK management include:

• Age: Children may respond quickly to steroids, but recurrences are common 6
• Disease duration: Prolonged disease course may increase the risk of corneal scarring 2
• Treatment response: Patients who do not respond to initial treatment may require alternative therapies or further evaluation 6