Early diagnosis of herpes simplex keratitis in children yields best outcomes
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 chart review of 35 patients aged 6 years and younger seen at a pediatric ophthalmology office in Shreveport, Louisiana, Omair B. Ali, MD, and colleagues looked at the following parameters: initial and final visual acuity, time to presentation to a pediatric ophthalmologist after symptom onset, initial missed diagnosis and presence of corneal scarring.
“Much better final visual acuities in most patients and marked reduction in corneal scarring” were demonstrated when children were seen early, co-author Nicolas Zaunbrecher, MD, said at the virtual American Association for Pediatric Ophthalmology and Strabismus annual meeting.
Of patients who were seen within 5 days of symptom onset, 63.2% had normal final visual acuity vs. 35.7% of patients presenting after 5 days, Zaunbrecher said. Mild to moderate visual loss was seen in 58.7% of patients presenting after 5 days and in only 26.3% of those presenting earlier. All patients were treated with oral acyclovir 80 mg/kg per day.
Worse initial visual acuity, an average of 20/100 in verbal children, was associated with presentation after 5 days, whereas better initial visual acuity, 20/25, was associated with earlier presentation.
Missed diagnoses, most commonly bacterial or adenoviral conjunctivitis and corneal abrasion, contributed to later presentation. Corneal scarring 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 reduction of final visual acuity and corneal scarring,” Zaunbrecher said.
Because between 75% and 90% of cases of herpetic keratitis are unilateral, corneal scarring “can result in the additional complication of amblyopia, which must be treated promptly,” the authors said.
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Ali OB, et al. Visual outcomes of herpes simplex keratitis in children age 6 years and younger. Presented at: American Association for Pediatric Ophthalmology and Strabismus annual meeting; April 9-11, 2021 (virtual meeting).
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