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Ocular surface disease in children

Dermot McGrath

Posted: Wednesday, April 8, 2020

Dominique Brémond-Gignac MD, PhD

Ocular surface diseases (OSD) in paediatric patients can have a severe impact on children’s quality of life, so rapid intervention with targeted treatment is essential to avoid vision-threatening complications associated with more severe forms of OSD, according to Dominique Brémond-Gignac MD, PhD.
“These are young and active patients and ocular surface disease can really have a devastating impact on their quality of life. Fortunately we do have a large arsenal of treatment options available to us with some recent innovative therapies showing promise in the treatment of some of the less common and more severe forms of OSD,” she told delegates attending a World Society of Paediatric Ophthalmology and Strabismus (WSPOS) symposium held during the European Society of Ophthalmology (SOE) meeting in Nice, France.
Allergic diseases are among the most common ocular surface disorders in children, said Prof Brémond-Gignac, and can take multiple forms. Mild-to-severe seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC) are common, as are mild acute forms of ocular allergy, usually accompanied by seasonal allergic rhinitis.
More serious, however, are vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC), both of which are rare diseases and may lead to visual impairment, she said. VKC primarily affects boys from 3-to-16 years of age and is characterised by serous discharge and corneal complications such as superficial punctate keratopathy (SPK) and shield ulcers. AKC is rare in children and often presents with clinical features such as keratitis, hyperaemia, thickened dry skin, papillae, Dennie-Morgan folds and blepharitis, she said.
“Differential diagnosis is important between these two diseases as the prognosis is not the same. VKC tends to end with adolescence, which is not the case with AKC, and the treatment strategy is not the same,” she said.
While topical corticosteroids are effective in moderate-to-severe disease, their use must be carefully controlled to reduce the risk of severe adverse effects such as cataracts, glaucoma and secondary corneal infections, said Prof Brémond-Gignac, as well as steroid dependence.
“We need more targeted and appropriate treatment with less steroid use where possible to avoid iatrogenic complications such as glaucoma and cataract in these young patients,” she said.
To that end, she said that the recent VErnal KeratoconjunctiviTIs Study (VEKTIS) study found that steroid-saving topical cyclosporine A was effective in the treatment of VKC and significantly improved signs and symptoms without significant side-effects.
Another topical agent, tacrolimus, also holds promise in the treatment of severe VKC refractory to topical antihistamine agents and topical cyclosporine, she added.

Dominique Brémond-Gignac: dominique.bremond@aphp.fr