Pediatric herpes simplex of the anterior segment: characteristics, treatment, and outcomes.
OBJECTIVE
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.


METHODS
Retrospective case series.


METHODS
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.


METHODS
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.
Schepens Eye Research Institute, Boston, Massachusetts, USA.
Shaohui
S
Liu
Deborah
D
Pavan-Langston
Kathryn A
KA
Colby
D015075:2-Aminopurine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000212:Acyclovir / Q000008:administration & dosage / Q000031:analogs & derivatives; D000287:Administration, Topical; D000293:Adolescent; D017668:Age of Onset; D000869:Anterior Eye Segment / Q000187:drug effects / Q000473:pathology* / Q000821:virology; D000998:Antiviral Agents / Q000008:administration & dosage; D001762:Blepharitis / Q000175:diagnosis / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D003236:Conjunctivitis, Viral / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology; D015828:Eye Infections, Viral / Q000175:diagnosis* / Q000188:drug therapy* / Q000821:virology; D000077595:Famciclovir; D005260:Female; D006561:Herpes Simplex / Q000175:diagnosis* / Q000188:drug therapy* / Q000821:virology; D018259:Herpesvirus 1, Human / Q000472:pathogenicity*; D006801:Humans; D007223:Infant; D016849:Keratitis, Herpetic / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology; D008297:Male; D009824:Ointments; D012189:Retrospective Studies; D014271:Trifluridine; D000077483:Valacyclovir; D014633:Valine / Q000008:administration & dosage / Q000031:analogs & derivatives; D014740:Vidarabine / Q000008:administration & dosage
D000998:Antiviral Agents; D009824:Ointments; D015075:2-Aminopurine; D014740:Vidarabine; D014633:Valine; D000077483:Valacyclovir; D000077595:Famciclovir; D014271:Trifluridine; D000212:Acyclovir