Management of Herpes Simplex Virus Keratitis in the Pediatric Population

Abstract

Herpes simplex virus (HSV) keratitis is a highly prevalent and visually disabling disease in both the pediatric and adult population. While many studies have investigated the treatment of HSV keratitis in adult patients, few have focused on managing this condition in children. Children are at particularly high risk for visual morbidity due to unique challenges in diagnosis and treatment, and the often more aggressive disease course that results in corneal scarring, and subsequently amblyopia. This review presents the pathogenesis and most current recommendations for the medical and surgical management of HSV keratitis in the pediatric population.

The Spectrum of Microbial Keratitis: An Updated Review

“…However, as reported in the literature and Karsten, Watson & Foster (2012) only 20-30% of adults develop ocular manifestations from HSV infections [319]. Nonetheless, herpetic eye disease remains a significant cause of blindness worldwide, affecting over 1 million people annually [320].…”

Ocular Manifestations of Herpes Simplex Virus in the Pediatric Population

“…39 As many as three quarters of children with HSV keratitis can develop damage to the corneal nerve plexus with resultant neurotrophic ulceration and corneal scarring. 6,17,29 Although neurotrophic ulcers can be managed with aggressive lubrication, topical medications, and amniotic membrane transplantation, surgical solutions such as corneal neurotization have shown long-term promise in prior studies. [43][44][45][46][47][48] Many of the same issues that complicate postoperative courses in adults undergoing corneal transplantation affect children at higher rates and with more severe manifestations, including graft failure, recurrent HSV or other infectious keratitis, glaucoma, and phthisis.…”

Advancement on Sustained Antiviral Ocular Drug Delivery for Herpes Simplex Virus Keratitis: Recent Update on Potential Investigation

“…Without appropriate and prompt treatment, patients may suffer prolonged infection, making them susceptible to recurrent keratitis [9][10][11]. Although the symptoms typically affect the unilateral eye, bilateral infection is common in younger age groups and immunocompromised patients [12]. Compared to adults, children have overall worse visual outcomes and hence they are at greater risk of permanent vision loss from amblyopia [12].…”

“…Although the symptoms typically affect the unilateral eye, bilateral infection is common in younger age groups and immunocompromised patients [12]. Compared to adults, children have overall worse visual outcomes and hence they are at greater risk of permanent vision loss from amblyopia [12]. The HSK manifestations can be categorised according to epithelial keratitis, stromal keratitis, and endotheliitis [1,5].…”

“…Although the symptoms typically affect the unilateral eye, bilateral infection is common in younger age groups and immunocompromised patients [12]. Compared to adults, children have overall worse visual outcomes and hence they are at greater risk of permanent vision loss from amblyopia [12]. Furthermore, the impact of the disease in developing nations with limited access to treatment and immunosuppression perhaps contributes to a significantly higher visual morbidity than currently known [3,12].…”