Topical cyclosporin A in Thygeson's superficial punctate keratitis

Background: Since September 1994 we have administered topical cyclosporin A 2% (CSA) in a prospective study to patients with Thygeson's superficial punctate keratitis (TSPK). After our promising short-term results we now present medium-term data of a larger patient group. Patients and methods: Topical CSA was administered to 52 eyes of 28 patients with TSPK. Forty-two were adult eyes (group I), 10 children's eyes (group II). Starting with 3 drops daily during the 1st month, CSA was reduced to 1 drop every 2nd day within 4 months and stopped after 6 months. Results: Complete suppression of the typical epithelial and supepithelial opacities could be achieved in 71.5% of cases in group I and 40% in group II as long as therapy was administered; the other patients responded only partially or not at all. Recurrences were a problem during tapering off or shortly after cessation of therapy, but they could again be treated effectively with the initial CSA regime. Thirty-one percent,of all adult eyes and 20% of all pediatric eyes seemed to have completely healed during the observation time. Conclusions: In more than two thirds of our adult patients topical CSA 2% suppresses the epithelial and subepithelial opacities for as long as this non-steroid therapy is administered. Definite healing seems to be achieved in almost one third of all adult patients. In another one third, long-term low-dose CSA therapy is necessary before complete healing may be expected. Children probably do not respond to therapy as well as adults. Whereas the only therapeutic alternative, i.e. steroid eye drops, have a significant potential for side effects in the long run, no side effects have been known from low-dose CSA eye drops. We regard CSA eye drops as a significant progress in the symptomatic treatment of TSPK.