Anyone who is invaded by herpes simplex keratitis (HSK) must know its "power", right? Its incidence trend is increasing year by year, ranking second among corneal diseases, and the first in case of no disease.
However, at present, most studies focus on adult herpes simplex keratitis, while there are relatively few studies on children's herpes simplex keratitis. Few people pay attention to the symptoms and manifestations of children's disease, so many people do not know that the complications of children's herpes simplex keratitis are more serious than those of adults.
In order to let us know the truth behind herpes simplex keratitis in children, today we will unveil the "mysterious veil" that is rarely uncovered, and tell us what are the similarities and differences between it and adult herpes simplex keratitis.
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In fact, the high risk factors of the two are similar. They usually occur when the resistance decreases or the immune system functions change, such as fever, pneumonia, upper respiratory tract infection or ear infection.
In addition, the clinical manifestations of herpes simplex keratitis in children are not significantly different, most of them are intermittent repeated redness, tears and photophobia, and corneal perception is reduced, but children with viral infection are more likely to cause systemic spread, such as herpes simplex virus pneumonia.
Moreover, the misdiagnosis rate of herpes simplex keratitis in children is higher than that in adults, so differential diagnosis is very important. For example, non-specific viral conjunctivitis, epidemic keratoconjunctivitis and marginal staphylococcal keratitis are often mistaken for herpes simplex keratitis.
Their common types are also roughly the same, including epithelial type, matrix type, endothelial type and neurotrophic disorder type. But the most common types are different: the former is the most common type of stromal keratitis, while the latter is the most common type of herpes simplex virus keratitis.
It is worth noting that the treatment of stromal keratitis is more difficult than that of epithelial keratitis, and the prognosis of vision is poor, even with the risk of amblyopia.
Moreover, the incidence rate of herpes simplex keratitis involving both eyes in children is also more common than that in adults. In a series of large studies, the incidence rate of herpes simplex keratitis involving both eyes in children is 10%~26%.
In fact, the ratio of sequelae and complications of bilateral herpes simplex keratitis is higher than that of unilateral keratitis. After the keratitis subsides, the eyes usually form matrix turbidity to varying degrees, and are more likely to recur than unilateral keratitis. At least half of children with herpes simplex keratitis will relapse within 1-2 years, usually within 12-15 months after the first infection.
The complications of herpes simplex keratitis in children include astigmatism, amblyopia, high intraocular pressure, corneal vascularization, corneal perforation, secondary bacterial keratitis, uveitis, etc. It is worth noting that the prognosis of herpes simplex keratitis in children is worse than that in adults, and the complications are more serious.
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The goal of herpes simplex keratitis treatment is to minimize corneal scar, delay matrix damage, and improve the visual quality of patients.
Its main treatment is local or oral antiviral drugs. Compared with adults, children have poor coordination and compliance, and the phenomenon of tears diluting drugs may occur when using local drugs. At this time, oral drugs can be selected.
Of course, penetrating keratoplasty can be used for herpes simplex keratitis in children when necessary (such as obvious corneal scar or new blood vessels), but parents need to be prepared, because penetrating keratoplasty in children is more difficult than adults in terms of surgical techniques and postoperative prevention and follow-up.
In a word, the diagnosis, treatment, prevention and evaluation of treatment effect of herpes simplex keratitis in children are complicated. Parents should pay close attention to the children's eye state and go to the hospital when necessary.