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Published on: September 20, 2021
Pediatric herpes simplex of the anterior segment: characteristics, treatment, and outcomes
Shaohui Liu1, Deborah Pavan-Langston, Kathryn A Colby
1Schepens Eye Research Institute, Boston, Massachusetts, USA.
Insights
Pediatric herpes simplex virus (HSV) eye infections, particularly herpes simplex keratitis (HSK), often present with misdiagnosis and significant vision loss. Effective management with oral acyclovir requires dosage adjustments as children grow to prevent recurrence.
Area of Science:
- Ophthalmology
- Virology
- Pediatric Infectious Diseases
Background:
- Herpes simplex virus (HSV) infections of the cornea and adnexae are significant causes of pediatric eye disease.
- Early and accurate diagnosis is crucial for effective management and preventing long-term complications.
Purpose of the Study:
- To characterize the clinical features, treatment strategies, and outcomes of HSV infections in pediatric patients.
- To enhance awareness and improve the clinical management of HSV keratitis (HSK) and HSV blepharoconjunctivitis (HBC) in children.
Main Methods:
- A retrospective case series analysis of 53 pediatric patients (57 eyes) treated for HSV eye infections.
- Data collected included demographics, clinical presentation, diagnostic delays, treatment regimens, and disease recurrence.
- Outcomes assessed included visual acuity, corneal scarring, and recurrence rates, particularly in patients on prophylactic oral acyclovir.
Main Results:
- The median age of onset was 5 years, with a high rate of misdiagnosis (30%) in HSK cases.
- Seventy-nine percent of patients with keratitis developed corneal scarring, and 26% had reduced vision at the final visit.
- Eighty percent of patients experienced recurrent disease; oral acyclovir was effective but required dosage adjustments for growth spurts.
Conclusions:
- Pediatric HSK is associated with frequent misdiagnosis, stromal involvement, recurrence, and vision impairment.
- Long-term oral acyclovir is beneficial for preventing recurrence but necessitates careful dosage monitoring and adjustment based on patient growth.
Purpose:
To describe the clinical characteristics, treatment, and outcomes of herpes simplex virus (HSV) infections of the cornea and adnexae to raise awareness and to improve management of this important eye disease in children.
Design:
Retrospective case series.
Participants:
Fifty-three patients (57 eyes) 16 years of age or younger with HSV keratitis (HSK), HSV blepharoconjunctivitis (HBC), or both in an academic cornea practice.
Methods:
The following data were collected: age at disease onset, putative trigger factors, coexisting systemic diseases, duration of symptoms and diagnoses given before presentation, visual acuity, slit-lamp examination findings, corneal sensation, dose and duration of medications used, drug side effects, and disease recurrence.
Main Outcome Measures:
Presence of residual corneal scarring, visual acuity at the last visit, changes in corneal sensation, recurrence rate, and manifestations of HSK were assessed in patients receiving long-term prophylactic systemic acyclovir.
Results:
The median age at onset was 5 years. Mean follow-up was 3.6 years. Eighteen eyes had HBC only; 4 patients in this group had bilateral disease. Of 39 eyes with keratitis, 74% had stromal disease. Thirty percent of HSK cases were misdiagnosed before presentation. Seventy-nine percent of patients with keratitis had corneal scarring and 26% had vision of 20/40 or worse at the last visit. Eighty percent of patients had recurrent disease. Six of 16 patients (37%) receiving long-term oral acyclovir had recurrent HSV, at least one case of which followed a growth spurt that caused the baseline dosage of acyclovir to become subtherapeutic.
Conclusions:
In a large series, pediatric HSK had a high rate of misdiagnosis, stromal involvement, recurrence, and vision loss. Oral acyclovir is effective, but the dosage must be adjusted as the child grows.
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