Severe bacterial corneal abscesses in children

Introduction: Corneal abscess is a severe condition with a guarded prognosis and potential for blindness. Diagnosis relies on clinical evaluation, necessitating prompt and appropriate management to prevent delays in diagnosis and therapy that could adversely affect visual outcomes. The objective of our study is to characterize the epidemiological, microbiological, clinical, therapeutic, and prognostic aspects of corneal abscesses in pediatric patients. Material and methods: We conducted a retrospective study that included all cases of confirmed bacterial corneal abscesses in hospitalized children over a 2-year period. Each child underwent corneal scraping with microbiological examination, and data were collected from their medical record Results: The total number of cases was 18 patients with 18 eyes, with an average age of 3 years and a male predominance. Pain and ocular redness were the main functional signs. Visual acuity was difficult to assess due to the young age of the patients. The pathogens identified were gram-positive bacteria in 55.5% of cases, gram-negative bacteria in 33.5%, and polymicrobial in 11%. Contributing factors included ocular trauma, history of ocular surgery, ocular dryness, and ocular rosacea. Initial treatment consisted of broad-spectrum antibiotic therapy with fortified ceftazidime and vancomycin eye drops combined with systemic antibiotics. Treatment was subsequently adjusted based on microbiological results and clinical progression. An antifungal agent was added for suspected superinfected fungal keratitis, using voriconazole eye drops. An antiviral was added for suspected superinfected herpetic keratitis, with oral acyclovir. The average duration of treatment was 3 weeks. In 66.5% of cases, the outcome was favorable with improved visual acuity and reduced corneal opacity. Discussion: The risk factors for corneal abscess are primarily ocular trauma in developing countries and contact lens wear in developed countries. In our series, the most significant risk factors were ocular trauma and a history of ocular surgery. The frequency of pathogens responsible for corneal abscess varies from region to region and depends on geographical location and climate. Consistent with the literature, in our series, the most common pathogens were gram-positive bacilli (55.5%). Initial treatment should be broad-spectrum targeting both gram-negative and gram-positive bacteria, and subsequently adjusted based on microbiological results. This approach aims to achieve optimal therapeutic efficacy and improve clinical outcomes Conclusion: The corneal abscess is a serious infection that affects visual prognosis. Faced with a severe corneal abscess, only rapid and well-conducted diagnostic and therapeutic management can reduce the risk of an unfavorable outcome. Similarly, prevention involves better management of ocular trauma and other causal factors.