title: Severity of pediatric blepharokeratoconjunctivitis in Asian eyes.
abstract: OBJECTIVE
  To describe and evaluate the severity of pediatric blepharokeratoconjunctivitis in Asia.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Clinical records of patients diagnosed with pediatric blepharokeratoconjunctivitis at a tertiary referral center in Singapore from 1991 through 2010 were reviewed. Patients were graded as having mild (corneal involvement without scarring), moderate (corneal scarring), or severe (corneal scarring with thinning or perforation) disease based on recorded clinical findings.
  
  
  RESULTS
  Fifty-one patients were diagnosed with pediatric blepharokeratoconjunctivitis. The mean age at presentation was 10.2 ± 3.6 years, most patients were female (80.4%), and the mean duration of follow-up was 58.9 ± 44.0 months. Chinese (56.9%) subjects made up most of the cases. Most subjects had moderate (56.9%), followed by severe (37.4%) and mild (5.9%), disease. Four patients (7.9%) had an associated dermatologic disease. All patients were treated with topical antibiotics, and 98% were treated with topical steroids. Nineteen (37.3%) patients received systemic antibiotic therapy, and 1 received systemic steroid therapy. Three patients required deep lamellar keratoplasty (2 tectonic and 1 optical), and 2 underwent cornea gluing alone; all 5 of them were Chinese. Patients graded as having severe disease were more likely to undergo surgical intervention (26.3%) than patients who were graded as having moderate (0%) and mild (0%) disease (P < .05). The main complication of treatment was raised intraocular pressure in 7 (13.7%) patients requiring medical therapy. Overall, best-corrected visual acuity improved by 0.10 logarithm of the minimal angle of resolution units (P < .001) after appropriate medical and surgical intervention.
  
  
  CONCLUSIONS
  Pediatric blepharokeratoconjunctivitis patients in Asia seem to have a more severe clinical presentation and course. Early and adequate management can arrest the disease process and can minimize visual morbidity.
authors.affiliation: Singapore Eye Research Institute, Singapore, Republic of Singapore.
authors.forename: Livia
authors.initials: L
authors.lastname: Teo
authors.forename: Jodhbir S
authors.initials: JS
authors.lastname: Mehta
authors.forename: Hla M
authors.initials: HM
authors.lastname: Htoon
authors.forename: Donald T H
authors.initials: DT
authors.lastname: Tan
mesh_terms: D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D044466:Asian People / Q000208:ethnology*; D001762:Blepharitis / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007637:Keratoconjunctivitis / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology*; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012846:Singapore / Q000453:epidemiology; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids