Topical Tacrolimus 0.1% in the Treatment of Thygeson’s Superficial Punctate Keratitis

Thygeson's superficial punctate keratitis (TSPK) is a rare and chronic eye condition characterized by recurrent flare-ups of symptoms such as photophobia and tearing. Various treatments have been attempted over the years, but none have been entirely successful in managing the condition. This report presents the case of a 21-year-old woman with bilateral TSPK who exhibited photophobia, tearing, and burning sensations. The patient was treated with an off-label non-ophthalmic topical tacrolimus 0.1% ointment, applied nightly into the inferior fornix and titrated with artificial tears to improve tolerance. Complete resolution of corneal lesions and symptoms was observed after three weeks, so the treatment was stopped. Although lesions reappeared following cessation of treatment, symptomatic relief persisted. This case highlights the potential of non-ophthalmic tacrolimus 0.1% ointment, a higher-concentration formulation not previously described in the TSPK literature, as an effective therapeutic option that may contribute to prolonged symptom control while avoiding the intraocular pressure risks associated with steroid use, particularly in young patients. Tacrolimus may represent a promising alternative therapy for patients requiring chronic management of TSPK.