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S. Jones, J. Weinstein, K.K. Nischal; Corneal And Visual Changes In Children With Severe Blepharokeratoconjunctivitis . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3570.
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Keratitis associated with blepharoconjunctivitis has been infrequently reported in children, though it is well documented in adults. Moreover the effect of blepharokeratoconjunctivitis on visual function has not been reported which is most important in relation to paediatric ophthalmology. This study evaluates the effect of chronic neglected blepharokeratoconjunctivitis upon the cornea and vision in children.
The medical records of 22 children with chronic blepharokeratoconjunctivitis were reviewed retrospectively. Data reviewed included complete ophthalmologic records with particular attention to patient age, sex, date and age at onset of symptoms, visual acuity at diagnosis, nature and site of corneal and eyelid pathology, and concomitant ocular disease during the course of treatment, including amblyopia. Outcome parameters assessed at the last visit included status of corneal and eyelid inflammation, visual acuity, and presence or absence of amblyopia.
The mean age at presentation was 7.9 years (range 7 months to 15 yrs, median 7.8 years). Follow–up ranged from 5 to 52 months (mean 16.5 months). Discomfort and conjunctival injection were the most common presenting complaints and were present in all 22 children. Photophobia was recorded in 13 patients. Signs of posterior blepharitis were reported in all 22 patients. Acne rosacea was confirmed in 3 patients. Visual acuity was reduced by central or paracentral corneal infiltrates in 13 patients (12 unilateral, 1 bilateral). Superimposed amblyopia was present and required treatment in 11 patients. Management protocol in all children included lid hygiene, warm compresses, oral antibiotics (erythromycin except in teenage children), topical antibiotics, and topical steroids. One child had a systemic side effect from oral antibiotics. No child had significant side effects on topical treatment.
Visual loss due to corneal inflammation is a serious complication of chronic blepharitis in children. Visual loss may occur either from central or paracentral corneal opacification, or from superimposed amblyopia. In the majority of cases, visual loss can be prevented by early diagnosis and aggressive topical and systemic therapy.
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