Keratitis in children

The diagnosis is usually established on the basis of microscopic examination and sowing of smears or scrapings from the cornea. If the patient receives treatment, it is advisable to temporarily cancel it 24 hours before the study.

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

Interstitial Keratitis

Causes:

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

Coin-like keratitis

Multiple small opacities in the anterior stroma of the cornea:

• adenoviral keratitis;
• herpes simplex;
• chicken pox - herpes zoster,
• the Epstein-Barr virus;
• sarcoidosis;
• onchocerciasis.

Epidemic keratoconjunctivitis

[6], [7]

Bacterial Keratitis

Predisposing factors

• Injury.
• Surgical intervention.
• Immunodeficiency.
• Long-term adverse effects on the cornea;
• Syndrome of "dry eyes".
• Wearing contact lenses.
• Severe common diseases.
• Trichiasis.
• Ionizing irradiation is the "dry eye" syndrome.
• Long-term instillations of steroid preparations.
• The use of keratotoxic drugs.

Infectious agents

The causative agent of the disease may indicate certain clinical manifestations.

1. Pseudomonas causes the appearance of rapidly progressing corneal ulcers with leukomalacia phenomena. The process especially affects children of small age and patients using contact lenses.
2. Moraxella causes conjunctivitis of the outer corner of the eye gap.
3. Staphylococcus spp.
   • trauma, surgical intervention or prolonged exposure to adverse factors;
   • Staph, aureus can provoke the appearance of a corneal ulcer with a concomitant hypopion.
4. Streptococcus:
   • use of contact lenses;
   • local damage to the corneal tissue;
   • chronic dacryocystitis;
   • rapidly progressing corneal ulcers with an eroded edge.
5. Gonococcus.
6. Gram-negative flora:
   • E. Coli;
   • Aerobacter,
   • Proteus spp.;
   • Klebsiella spp.

Have tropism to the cornea, especially if there are background diseases.

Keratitis caused by Pseudomonas in a newborn. Predisposing factors are not identified

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

Injection of the eyeball in early childhood

1. Conjunctivitis:
   • detachable, conjunctival injection;
   • lacrimation, visual acuity is not reduced.
2. Keratitis:
   • conjunctival injection, discomfort, lacrimation;
   • separable, photophobia.
3. Endophthalmitis:
   • pain, low vision, mixed injection;
   • lachrymation, detachable.
4. Uveitis:
   • pain, photophobia, blurred vision;
   • mixed injection, lacrimation.
5. Chorioretinitis:
   • low vision, floating opacities before the eye, eyeball injection;
   • hemorrhage under the conjunctiva, injection of the eyeball.
6. Glaucoma:
   • pain, mixed injection;
   • photophobia, low vision.
7. Infiltration of the conjunctiva in leukemia:
   • local infiltration;
   • conjunctival injection.
8. Malformations of the vascular system:
   • Stirge-Weber Syndrome;
   • disturbance of the development of the vessels of the orbit.
9. Glued to:
   • pain, deep injection;
   • pain during movement.
10. Episcleritis:
    • local conjunctival and subconjunctival injection;
    • lacrimation, slight discomfort, a feeling of "dryness" in the eye, an injection, a scanty discharge.
11. Foreign body:
    • a local injection, a feeling of "sand" in the eye;
    • foreign body sensation.
12. Injury:
    • direct injury;
    • closed head trauma, causing the development of carotid cavernous fistula.

Viral keratitis

The main manifestation of viral keratitis caused by the herpes simplex virus is point clouding of the cornea. Sometimes, with acute primary infection, opacities are transformed into dendritic keratitis, usually combined with damage to the skin. Assign antiviral drugs, such as idoxuridine, triflurotimidine or acyclovir.

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

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

Keratitis of fungal etiology

Keratitis, due to fungal flora, occurs in weakened children or in the presence of concomitant diseases of the organ of vision. An example is immunologically weakened children receiving general steroid therapy, patients with long-term non-healing wounds, as well as traumatized eyes or those suffering from the syndrome of "dry" eyes.

Pathogens

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

Bilateral keratitis caused by Candida in a child with severe immunodeficiency

Characteristic signs - leukomalacia, torpid current, resistance to antibiotics and the emergence of satellites.

Keratitis caused by protozoa

Acanthamoeba keratitis occurs in people who use contact lenses and lovers to swim in salt water. Acanthamoeba causes chronic, slow healing ulcers and infiltrates of the corneal stroma in combination with anterior uveitis. The effect is provided by the installation of 0.1% propamidine isethionate, 0.15% dibromopropamidine, as well as the use of miconazole or neomycin.

Treatment of keratitis in children

All necrotic tissue is removed. Remove the wearing of contact lenses. Any adverse factors should be identified and eliminated. In some cases (small age of the child) it is advisable to prescribe sedatives. All patients require qualified care.

Treatment is prescribed immediately, before revealing the sensitivity of the flora to antibiotics. Recommended antibiotic installations every hour (or every half hour). It is desirable that antibiotics do not contain preservatives that have a toxic effect on the cornea. Use solutions of chloromycin, gentamicin or cephalosporin.