The lesions were more concentrated inferiorly but were seen even at the superior limbus. There was no evidence of HSV or any other anterior segment pathology. IOP was normal and fundi were benign. Conjunctival scrapings for culture and eosinophils were not helpful. There was an excellent response to Pred Forte and qhs ointment over the following weeks but recurrence of photophobia upon taper.
Exam is very difficult but there is never any associated conjunctivitis.
Medical history is remarkable only for food allergies but the parents deny any evidence of itching or eye rubbing. I am calling this Thygeson's SPK but have only treated this in adults. I am certainly concerned over the long term use of steroids in this 18 month old. I tried a course of Trifluridine without success. Please limit the length of the title of the response to 18 characters.