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[Chronic (kerato-) conjunctivitis refractory to therapy in children]
1Universität Zürich und OMMA Praxisgemeinschaft, Zürich. wolfgang.bernauer@hin.ch
Insights
Diagnosing chronic pediatric (kerato-)conjunctivitis is challenging, often leading to delayed treatment and persistent eye damage. Thorough clinical examination is key to accurate diagnosis and effective management of pediatric ocular inflammation.
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.
Background:
Chronic conjunctivitis and keratoconjunctivitis account for a significant ocular morbidity. Early diagnosis and appropriate management are essential to avoid persisting structural damage and visual loss. In children, the correct diagnosis is frequently delayed because of the low individual experience with pediatric ocular inflammation, the uncommon clinical manifestations and the rarity of some conditions. This study aims to identify the problems associated with the diagnosis of chronic pediatric (kerato-)conjunctivitis.
Patients And Methods:
48 consecutive tertiary referrals (median age: 8.5 years) with chronic conjunctivitis or keratoconjunctivitis were studied. The ocular inflammation of all patients was denoted by their referring ophthalmologists as "chronic conjunctivitis refractory to therapy". The median time since disease onset was 23 months (range: 3 - 118). On average, 2.8 (range: 2 - 5) ophthalmologists were seen before the final diagnosis was made. A standardized protocol was used to classify and diagnose the ocular inflammation. Laboratory investigations were carried out to confirm the diagnosis in 20 out of 48 patients.
Results:
In 33 out of 48 patients treatment failure was due to an inappropriate diagnosis. The most frequent diagnosis were Staphylococcus-associated inflammation (n = 21) and vernal keratoconjunctivitis (n = 12). Viral infection causing molluscum contagiosum was the most frequent condition that was missed (n = 7). Ligneous conjunctivitis (n = 2) was not recognised by the 9 ophthalmologists who were previously in charge of the treatment. Significant corneal involvement was found in 24 (50 %) patients.
Conclusion:
History taking and a thorough clinical examination of the entire ocular surface allow the correct diagnosis of and therapy for chronic surface inflammation in almost all pediatric patients. Subtle clinical changes have to be sought actively to avoid misdiagnosis. Such changes include lesions in the anterior lid margin, collarettes, follicules, papillae, and superficial punctate keratopathy.
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