[Chronic (kerato-) conjunctivitis refractory to therapy in children]

Area of Science:

• Ophthalmology
• Pediatric Ophthalmology
• Ocular Surface Disease

Background:

• Chronic conjunctivitis and keratoconjunctivitis cause significant ocular morbidity, especially in children.
• Delayed diagnosis in pediatric ocular inflammation stems from limited experience, unusual presentations, and rare conditions.
• This study addresses diagnostic challenges in chronic pediatric (kerato-)conjunctivitis.

Purpose of the Study:

• To identify diagnostic challenges in chronic pediatric (kerato-)conjunctivitis.
• To improve diagnostic accuracy and timely management of pediatric ocular surface inflammation.

Main Methods:

• Studied 48 pediatric tertiary referrals with chronic conjunctivitis/keratoconjunctivitis.
• Patients were previously diagnosed with "chronic conjunctivitis refractory to therapy".
• Utilized a standardized protocol and laboratory investigations for diagnosis.

Main Results:

• Treatment failure occurred in 33/48 patients due to misdiagnosis.
• Common misdiagnosed conditions included Staphylococcus-associated inflammation and vernal keratoconjunctivitis.
• Missed diagnoses included molluscum contagiosum (n=7) and ligneous conjunctivitis (n=2); 50% had corneal involvement.

Conclusions:

• Accurate diagnosis of chronic ocular surface inflammation in children is achievable with detailed history and comprehensive ocular surface examination.
• Actively seeking subtle clinical signs like lid margin lesions, papillae, and punctate keratopathy is crucial to prevent misdiagnosis.
• Early and correct diagnosis is essential to prevent structural damage and visual loss in pediatric patients.