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Microbial keratitis in childhood
1Bascom Palmer Eye Institute, University of Miami School of Medicine, Florida 33101-6880.
Insights
Childhood microbial keratitis is often linked to trauma or prior eye surgery, unlike adult cases. Early identification of these risk factors is crucial for prompt treatment in pediatric patients.
Area of Science:
- Ophthalmology
- Pediatric Infectious Diseases
- Microbiology
Background:
- Microbial keratitis is uncommon in children, with trauma and pre-existing corneal disease as primary risk factors.
- Age-related risk factors prevalent in adults are less significant in pediatric cases.
Purpose of the Study:
- To identify and differentiate risk factors for nonviral microbial keratitis in children compared to adults.
- To aid in the early recognition and treatment of microbial keratitis in pediatric populations.
Main Methods:
- Retrospective analysis of 51 eyes with ulcerative keratitis in 50 children (<16 years) treated between 1980 and 1991.
- Inclusion criterion: discharge diagnosis of microbial (nonviral) keratitis.
Main Results:
- Key risk factors included trauma (44%), prior corneal surgery (24%), systemic illness (14%), and contact lens wear (12%).
- Pseudomonas aeruginosa, Staphylococcus aureus, and fungi were common pathogens; 14% of eyes required surgery.
- Systemic illness or immunocompromise was noted in 47% of children under 3 years.
Conclusions:
- This study highlights distinct risk factors for childhood nonviral microbial keratitis.
- Understanding these pediatric-specific factors is essential for timely diagnosis and intervention.
Background:
Microbial keratitis occurs infrequently in childhood. The leading ocular predisposing factors are trauma and preexisting corneal disease. Many of the age-related risk factors in adults play a minor role in children.
Methods:
The authors retrospectively studied 51 eyes with ulcerative keratitis in 50 children younger than 16 years of age. This includes all patients treated at Bascom Palmer Eye Institute during an 11 1/2-year period from January 1, 1980, to June 30, 1991. The criterion for inclusion in the study was a discharge diagnosis of microbial (nonviral) keratitis.
Results:
The principal risk factors identified in this study were trauma (44%), prior corneal surgery (24%), systemic illness (14%), and contact lens wear (12%). Systemic illness or an immunocompromised state existed in 7 (47%) of the 15 children younger than 3 years of age. There was a large male preponderance (68%). Forty-four (86.3%) of the 51 eyes were culture-positive; six (11.7%) were polymicrobial. Five of seven culture-negative patients had received prior topical antibiotic therapy. Pseudomonas aeruginosa (34%), Staphylococcus aureus (20%), and fungi (18%) were the most common organisms isolated. Seven (14%) eyes required surgery.
Conclusion:
This study presents important differentiating factors between adult and childhood nonviral microbial keratitis. Identification of principal risk factors in children may aid in early recognition and treatment of microbial keratitis.