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Early diagnosis of herpes simplex keratitis in children yields best outcomes

April 12, 2021

1 min read

Source / Disclosures Published by:

Source:

Ali OB, et al. Visual outcomes of herpes simplex keratitis in children 6 years of age and younger. Presented at: American Association for Pediatric Ophthalmology and Strabismus Annual Meeting; April 9-11, 2021 (virtual meeting).

Disclosures:
Zaunbrecher does not report any relevant financial information.

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Visual outcomes of children with herpes simplex keratitis were better when patients were seen within 5 days of symptom onset, according to a poster presentation.

In a retrospective review of 35 patients 6 years and younger seen at a pediatric ophthalmic office in Shreveport, Louisiana, Omair B. AI, MD, and colleagues looked at the following parameters: initial and final visual acuity, time to presentation to a pediatric ophthalmologist after onset of symptoms, initial missed diagnosis and presence of corneal scars.

“Much better ultimate visual acuity in most patients and a marked reduction in corneal scarring” were demonstrated when children were seen early, said study co-author Nicolas Zaunbrecher, MD, at the American Association for Pediatric Ophthalmology and Strabismus virtual annual meeting.

Of the patients seen within 5 days of symptom onset, 63.2% had normal final visual acuity versus 35.7% of the patients who presented after 5 days, Zaunbrecher said. Mild to moderate vision loss was seen in 58.7% of patients who presented after 5 days and only 26.3% of those who presented before. All patients were treated with oral aciclovir 80 mg / kg per day.

Worse initial visual acuity, mean 20/100 in verbal children, was associated with presentation after 5 days, while better initial visual acuity, 20/25, was associated with earlier presentation.

Missed diagnoses, usually bacterial or adenoviral conjunctivitis and corneal abrasion, contributed to the later presentation. Corneal scars occurred in 61.9% of children with initial misdiagnosis and late presentation.

“Initial misdiagnosis by a primary care physician led to much higher rates of final visual acuity reduction and corneal scarring,” said Zaunbrecher.

Because between 75% and 90% of herpetic keratitis cases are unilateral, corneal scarring can “result in the concomitant complication of amblyopia, which must be treated immediately,” the authors said.

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American Association for Pediatric Ophthalmology and Strabismus

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