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A global perspective of pediatric non-viral keratitis: literature review

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Abstract

Purpose

This focused review aims to explore pediatric non-viral keratitis and to compare associated risk factors, etiologies, antibiotic susceptibilities, empiric treatments and outcomes.

Methods

The authors performed a literature research for articles, published on PubMed, Google Scholar, Scopus and Embase online library, relevant to pediatric keratitis etiology, risk factors, antibiotic susceptibilities, treatment and outcomes. From the bibliography of selected articles, additional relevant articles were also considered. Of 34 articles identified, 21 were suitable for the purpose of this review.

Results

Several risk factors are noted in the field of pediatric keratitis. Trauma is the most common in developing countries, while contact lenses wear is seen in developed economies. Previous ocular conditions and systemic diseases also contribute. Associated malnourishment and vitamin A deficit are fraught with a catastrophic prognosis. Among causative organisms, bacteria are more common than fungi and protozoa. Gram-positive organisms are predominant where contact lenses use is infrequent. Pseudomonas aeruginosa is often the leading pathogen in developed countries and is strongly associated with contact lens wear or malnourishment. Fungi are common in the tropics and associated with trauma. Levofloxacin seems the more effective empirical treatment when bacteria are suspected, but there is no agreement on a standard of care.

Conclusion

There are differences in etiologic patterns between developing and developed countries and different regions globally. Risk factors follow the same trend; however, there is no standard regimen being followed for empirical treatment of pediatric infectious keratitis. Associated malnourishment and vitamin A deficiency result in poorer outcomes.

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Author notes

  1. Antonio Di Zazzo and Marco Antonini have equally contributed to write the manuscript.

Authors and Affiliations

  1. Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy

    Antonio Di Zazzo, Marco Antonini, Giuseppe Varacalli, Roberto Sgrulletta & Marco Coassin

  2. Cornea and Anterior Segment Services, LV Prasad Eye Institute, GMR Varalakshmi Campus, Hanumanthawaka Jn, Visakhapatnam, Andhra Pradesh, 530040, India

    Merle Fernandes

Authors
  1. Antonio Di Zazzo
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  2. Marco Antonini
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  3. Merle Fernandes
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  4. Giuseppe Varacalli
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  5. Roberto Sgrulletta
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Contributions

ADZ and MA conceived and designed the manuscript. All authors analyzed the data. MA, ADZ and MF wrote the paper.

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Correspondence to Merle Fernandes.

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Di Zazzo, A., Antonini, M., Fernandes, M. et al. A global perspective of pediatric non-viral keratitis: literature review. Int Ophthalmol 40, 2771–2788 (2020). https://doi.org/10.1007/s10792-020-01451-z

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  • DOI: https://doi.org/10.1007/s10792-020-01451-z

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