Pediatric Non-Viral Microbial Keratitis: Predisposing Factors, Microbiological Profile, Treatment Modalities, and Visual Outcome

PURPOSE: To describe the predisposing factors, causative organisms, treatment modalities, and visual outcomes of childhood non-viral microbial keratitis in our region. PATIENTS AND METHODS: All cases with the clinical or microbiological diagnosis of non-viral microbial keratitis in patients ≤18 years presenting to Dhahran Eye specialist Hospital, a tertiary eye care hospital in Dhahran, Eastern Province, Saudi Arabia, between 2010 and 2020 were included. A retrospective chart review was conducted. Demographic data, predisposing factors, clinical characteristics, isolated microorganisms, and visual outcomes were recorded. RESULTS: Fifty-nine patients were included in this study, of which three cases were bilateral. The mean age was 9.3 ± 6.3 years (range: 14 days - 18 years). Predisposing factors were identified in 89.8% (n=53) of cases. Contact lens wear was the leading cause 35.6% (n=21), followed by trauma 27.1% (n=16), ocular diseases 11.9% (n=7), systemic diseases 10.2% (n=6), and ocular surgery 5.1% (n=3). Out of all cases, 66.1% (n=39) have undergone corneal scraping, out of which 43.6% (n=17) showed positive growth. Gram-negative organisms accounted for 47.1% (n=8) isolates of all culture-positive cases. Pseudomonas aeruginosa was the most common pure isolate, which accounted for 41.2% (n=7) of culture-positive cases, followed by Staphylococcus aureus 11.8% (n=2). The most common complication was corneal scar in 71.2% (n=42). Nineteen (32.2%) patients had poor outcome. Seven patients (11.9%) required further intervention, these included penetrating keratoplasty (n=1), deep lamellar keratoplasty (n=3), Photorefractive keratectomy (n=2), and Phototherapeutic keratectomy (n=1). CONCLUSION: Childhood non-viral microbial keratitis is uncommon; however, it carries significant risks. Most cases were associated with preventable risk factors, with contact lens wear being the leading cause. Early detection and management are mandatory to reduce the risk of vision-threatening complications. The difficulty in assessment should not jeopardize proper evaluation and management of suspected cases.