usa2009

10+ Year Member
Oct 15, 2008
31
0
Status
Optometry Student
Question for you guys...
I've had some asymptomatic CL wearer pts that upon examination i found significant SPK. In these cases i have Discontniued CL and either told them to use PF AT Q 2 hrs or also Rx'ed Zylet/Vigamox in more severe cases. However, in 1 or even 2 weeks FU i didn't see real improvement. I need some guidance on how you treat them successfully and how long does it usually take to have it completely clreared . Also for how long do you discontinue CL wear for pt with no symptoms. Thanks a lot
 

RadixLuminogen

Membership Revoked
Removed
Oct 16, 2013
93
13
First off, soft contact lenses are indicated to treat SPK, antibiotics are NOT efficacious in SPK and low-dose corticosteroids such as FML are the mainstay of treatment. Restasis works too. Or you could have just google'd this..
 

310

5+ Year Member
Nov 10, 2012
173
29
Status
Optometrist
1. Vigamox causes spk and isn't indicated bc there isn't a bacterial infection. Zylet works but is more expensive than tobradex and pred, and doesn't work better than either of those.
2. There has to be a reason why they have they have the spk (i.e. misuse, postmenopausal women, solution allergy)
3. They're asymptomatic
Answer: (1, optional) d/c CL for a week and use steroid (2, much more important than 1) clear care, rewetting drops, no showers in lenses or overnight wear, get rid of them as directed; lens should be sihy
 

JMK2005

Member
10+ Year Member
15+ Year Member
Apr 3, 2004
678
19
Status
Attending Physician
First off, soft contact lenses are indicated to treat SPK, antibiotics are NOT efficacious in SPK and low-dose corticosteroids such as FML are the mainstay of treatment. Restasis works too. Or you could have just google'd this..
PEE is the more appropriate terminology. If the cause is contact lenses, the treatment is contact lens holiday. 2 weeks is good to start. Longer if minimal improvement. May takes 1-2 months to see improvement on exams as it takes time for corneal epithelium to resurface.
 

Commando303

10+ Year Member
7+ Year Member
Mar 12, 2009
911
18
Status
Unless it's ridiculous S.P.K./P.E.E., treatment probably isn't necessary in an asymptomatic patient.

That said, if you feel it's an oxygen issue, go to a higher-Dk/t lens. If you feel it's from a tight lens, go to a looser lens. If it makes sense to do so, change solutions, or try a peroxide-based option (e.g., ClearCare). If you feel it's from the build-up of crap, encourage decreasing wear-time and increased use of lubrication (as well as possibly switching to a peroxide-based disinfectant).
 
OP
U

usa2009

10+ Year Member
Oct 15, 2008
31
0
Status
Optometry Student
Thanks guys. But ,but in many pt's that i have been following after 2 weeks of not wearling CL's the patients did not show real improvement. I'm wondering why it's taking to long. In many asypmtoamtic pt's with mild-moderate amount of SPK and no complaints whatsoever , how long should you keep them away for CL wear ? Since some pt's dont accept not to wear the CL for a month. any suggestions?
 

RadixLuminogen

Membership Revoked
Removed
Oct 16, 2013
93
13
Thanks guys. But ,but in many pt's that i have been following after 2 weeks of not wearling CL's the patients did not show real improvement. I'm wondering why it's taking to long. In many asypmtoamtic pt's with mild-moderate amount of SPK and no complaints whatsoever , how long should you keep them away for CL wear ? Since some pt's dont accept not to wear the CL for a month. any suggestions?
I'll repeat again. CL wear makes them better.

http://www.ncbi.nlm.nih.gov/pubmed?Db=pubmed&Cmd=Retrieve&list_uids=6892542&dopt=abstractplus

You need to use corticosteroids if you want to clear them up. Lotemax, pred, FML
 
Last edited:

Commando303

10+ Year Member
7+ Year Member
Mar 12, 2009
911
18
Status
I'll repeat again. CL wear makes them better.

http://www.ncbi.nlm.nih.gov/pubmed?Db=pubmed&Cmd=Retrieve&list_uids=6892542&dopt=abstractplus

You need to use corticosteroids if you want to clear them up. Lotemax, pred, FML
S.C.L.-wear probably will not make such a patient better. I'm not sure how you've come to this conclusion, and I don't know what your point is in posting the citation you have (http://www.ncbi.nlm.nih.gov/pubmed?Db=pubmed&Cmd=Retrieve&list_uids=6892542&dopt=abstractplus) — it regards four patients, and it concerns Thygeson's...
 

Commando303

10+ Year Member
7+ Year Member
Mar 12, 2009
911
18
Status
This is why it's important to use correct terminology to differentiate between PEE and SPK...
Besides Thygeson's, nothing really conflicts with using the term "S.P.K." to describe what also is called "P.E.E." (punctate epithelial erosion). Honestly, I don't feel the former is a bad name for the latter, especially considering it can be an abbreviation for the accurate term, "superficial punctate keratopathy" (as in the sixth edition [2012] of the "Wills Eye Manual"), rather than for "superficial punctate keratitis."