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Pediatric herpes simplex of the anterior segment: characteristics, treatment, and outcomes.
Ophthalmology 2012; 119(10):2003-8O

Abstract

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.

Authors+Show Affiliations

Schepens Eye Research Institute, Boston, Massachusetts, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22796308

Citation

Liu, Shaohui, et al. "Pediatric Herpes Simplex of the Anterior Segment: Characteristics, Treatment, and Outcomes." Ophthalmology, vol. 119, no. 10, 2012, pp. 2003-8.
Liu S, Pavan-Langston D, Colby KA. Pediatric herpes simplex of the anterior segment: characteristics, treatment, and outcomes. Ophthalmology. 2012;119(10):2003-8.
Liu, S., Pavan-Langston, D., & Colby, K. A. (2012). Pediatric herpes simplex of the anterior segment: characteristics, treatment, and outcomes. Ophthalmology, 119(10), pp. 2003-8. doi:10.1016/j.ophtha.2012.05.008.
Liu S, Pavan-Langston D, Colby KA. Pediatric Herpes Simplex of the Anterior Segment: Characteristics, Treatment, and Outcomes. Ophthalmology. 2012;119(10):2003-8. PubMed PMID: 22796308.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pediatric herpes simplex of the anterior segment: characteristics, treatment, and outcomes. AU - Liu,Shaohui, AU - Pavan-Langston,Deborah, AU - Colby,Kathryn A, Y1 - 2012/07/13/ PY - 2011/12/01/received PY - 2012/05/03/revised PY - 2012/05/03/accepted PY - 2012/7/17/entrez PY - 2012/7/17/pubmed PY - 2012/12/20/medline SP - 2003 EP - 8 JF - Ophthalmology JO - Ophthalmology VL - 119 IS - 10 N2 - 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. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/22796308/Pediatric_herpes_simplex_of_the_anterior_segment:_characteristics_treatment_and_outcomes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(12)00413-7 DB - PRIME DP - Unbound Medicine ER -