Contact lens wear, trauma up risk of microbial keratitis in youths

In paediatric patients with microbial keratitis, the most significant risk factors are contact lens wear, trauma, and existing ocular disease, while pre-existing corneal disease and delay in presentation correlate with poor visual acuity, according to a study.

“The majority of patients have a good visual outcome, although serious complications are not uncommon and may cause lifelong visual disability,” the authors said.

This retrospective cohort study identified 80 patients aged ≤18 years with a clinical diagnosis of microbial keratitis presenting between 1 January 2010 and 31 December 2016 from hospital coding and pathology databases. The authors extracted data from medical records and analysed the epidemiology, predisposing factors, referral patterns, microbial profile, and treatment outcomes.

Eighty eyes from 80 paediatric patients (mean age, 11 years; range, 0–18 years; 55 percent male) were included in the analysis, of which eight had bilateral disease. Of the patients, 36 percent and 13.5 percent had ocular and systemic comorbidities, respectively.

Contact lens wear (26 percent), trauma (24 percent), and external lid and eye disease (20 percent) were significantly associated with developing microbial keratitis. Seventy-four organisms were identified, with Gram-positive organism being the most common isolate overall. Antimicrobial resistance to common antibiotics was low across all isolates.

Following treatment, visual acuity was worse than 6/60 for seven patients (11.3 percent), 6/15–6/60 for 15 patients (24.2 percent), and better than 6/12 for majority of the patients (n=40; 64.5 percent). Worse visual prognosis was predicted by pre-existing corneal disease and delay or presentation. Sixteen patients (21.3 percent) had serious complications.