Keratitis in children

The diagnosis is usually made by microscopic examination and culture of smears or scrapings from the cornea. If the patient is receiving treatment, it is advisable to temporarily discontinue it 24 hours before the examination.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ]

Interstitial keratitis

Reasons:

• leprosy;
• tuberculosis;
• onchocerciasis;
• herpes simplex;
• measles.

Nummular keratitis

Multiple small opacities in the anterior corneal stroma:

• adenoviral keratitis;
• herpes simplex;
• chickenpox - herpes zoster,
• Epstein-Barr virus;
• sarcoidosis;
• onchocerciasis.

Epidemic keratoconjunctivitis

[ 6 ], [ 7 ]

Bacterial keratitis

Predisposing factors

• Injury.
• Surgical intervention.
• Immunodeficiency.
• Long-term exposure of the cornea to adverse factors;
• Dry eye syndrome.
• Wearing contact lenses.
• Severe general diseases.
• Trichiasis.
• Ionizing radiation - dry eye syndrome.
• Long-term instillation of steroid drugs.
• Use of keratotoxic drugs.

Infectious agents

Certain clinical manifestations may indicate the causative agent of the disease.

1. Pseudomonas causes rapidly progressing corneal ulcers with leukomalacia. The process especially often affects young children and patients using contact lenses.
2. Moraxella causes conjunctivitis of the outer canthus.
3. Staphylococcus spp.
   • trauma, surgery or prolonged exposure to adverse factors;
   • Staph, aureus can provoke the development of a corneal ulcer with accompanying hypopyon.
4. Streptococcus:
   • use of contact lenses;
   • local damage to corneal tissue;
   • chronic dacryocystitis;
   • rapidly progressing corneal ulcers with undermined edges.
5. Gonococcus.
6. Gram-negative flora:
   • E. coli;
   • Aerobacter,
   • Proteus spp.;
   • Klebsiella spp.

They have affinity for the cornea, especially in the presence of underlying diseases.

Pseudomonas keratitis in a newborn. No predisposing factors identified

[ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 12 ], [ 13 ]

Eyeball injection in early childhood

1. Conjunctivitis:
   • discharge, conjunctival injection;
   • lacrimation, visual acuity is not reduced.
2. Keratitis:
   • conjunctival injection, discomfort, lacrimation;
   • discharge, photophobia.
3. Endophthalmitis:
   • pain, low vision, mixed injection;
   • lacrimation, discharge.
4. Uveitis:
   • pain, photophobia, blurred vision;
   • mixed injection, lacrimation.
5. Chorioretinitis:
   • low vision, floaters in front of the eye, eyeball injection;
   • subconjunctival hemorrhage, eyeball injection.
6. Glaucoma:
   • pain, mixed injection;
   • photophobia, low vision.
7. Conjunctival infiltration in leukemia:
   • local infiltration;
   • conjunctival injection.
8. Vascular system malformations:
   • Sturge-Weber syndrome;
   • disturbance of development of orbital vessels.
9. Sclerites:
   • pain, deep injection;
   • pain when moving.
10. Episcleritis:
    • local conjunctival and subconjunctival injection;
    • lacrimation, mild discomfort, feeling of "dryness" in the eye, injection, scanty discharge.
11. Foreign body:
    • local injection, sensation of "sand" in the eye;
    • foreign body sensation.
12. Injury:
    • direct trauma;
    • closed head injury causing the development of carotid-cavernous fistula.

Viral keratitis

The main manifestation of viral keratitis caused by the herpes simplex virus is punctate opacities of the cornea. Sometimes, in acute primary infection, opacities are transformed into dendritic keratitis, usually combined with skin lesions. Antiviral drugs such as idoxuridine, triflurotimidine or acyclovir are prescribed.

Keratitis characterized by the formation of deep infiltrates without signs of purulent inflammation (for example, discoid) occurs. In these cases, treatment is carried out with antiviral agents in combination with steroid drugs.

Other viral keratitis that are not prone to purulent inflammation and ulceration include adenoviral keratitis, keratitis in molluscum contagiosum, papillomatous and warty forms of the disease, and the Epstein-Barr virus.

Keratitis of fungal etiology

Keratitis caused by fungal flora occurs in weakened children or in the presence of concomitant diseases of the organ of vision. Examples are immunologically weakened children receiving general steroid therapy, patients with long-term non-healing wounds, as well as those who have suffered an eye injury or suffer from dry eye syndrome.

Pathogens

• Actinomyces.
• Candida.
• Nocardia.
• Fusarium.
• Mold.

Bilateral Candida keratitis in a severely immunocompromised child

Characteristic signs are leukomalacia, torpid course, resistance to antibiotics and the emergence of satellite foci.

Keratitis caused by protozoa

Acanthamoeba keratitis occurs in contact lens wearers and salt water bathers. Acanthamoeba causes chronic, slow-healing ulcers and corneal stromal infiltrates in association with anterior uveitis. Instillations of 0.1% propamidine isethionate, 0.15% dibromopropamidine, and miconazole or neomycin are effective.

Treatment of keratitis in children

All dead, necrotic tissue is removed. Contact lenses are discontinued. Any unfavorable factors should be identified and eliminated. In some cases (young child), it is advisable to prescribe sedatives. All patients require qualified care.

Treatment is prescribed immediately, before the flora sensitivity to antibiotics is detected. Antibiotic instillations are recommended every hour (or every half hour). It is desirable that the antibiotics do not contain preservatives that have a toxic effect on the cornea. Chloromycin, gentamicin or cephalosporin solutions are used.