Pediatric Ocular Surface Disorders
Özet
Ocular surface disorders in the pediatric population constitute a clinically demanding group of conditions that differ substantially from their adult counterparts, both in their underlying mechanisms and in the way they present. The immature corneal innervation, the evolving tear film composition, and the immunologically active conjunctiva-associated lymphoid tissue of the developing eye collectively create a milieu in which inflammatory and hypersensitivity responses can be intense, yet symptoms may remain subtle or absent. Children frequently cannot articulate their discomfort, and the clinician must rely on behavioral cues — persistent eye rubbing, photophobia, recurrent redness — as well as objective findings to reach a timely diagnosis. Delay carries a real cost: amblyopia, irreversible corneal scarring, and the compounding effects of chronic illness during critical windows of visual development. This chapter covers the full spectrum of pediatric ocular surface disease, from allergic conditions including vernal keratoconjunctivitis, atopic keratoconjunctivitis, and giant papillary conjunctivitis, to infectious keratoconjunctivitis, pediatric blepharokeratoconjunctivitis, phlyctenular keratoconjunctivitis, ocular rosacea, and dry eye disease, as well as the severe, sight-threatening sequelae of Stevens-Johnson syndrome and ocular graft-versus-host disease. Current management strategies are discussed with an emphasis on early immunomodulation, steroid-sparing regimens, and the emerging role of biologic therapies and regenerative medicine in children who do not respond to conventional treatment.
Pediatrik popülasyonda oküler yüzey hastalıkları, hem altta yatan mekanizmalar hem de klinik prezentasyon açısından erişkin hastalıktan belirgin biçimde ayrılan, tanısal ve terapötik güçlükler sunan geniş bir hastalık grubunu oluşturmaktadır. Gelişmekte olan gözde immatür korneal innervasyon, olgunlaşma sürecindeki gözyaşı filmi bileşimi ve immünolojik açıdan aktif konjonktiva ilişkili lenfoid doku bir arada, inflamatuar ve aşırı duyarlılık yanıtlarının şiddetli seyredebildiği ancak semptomların zaman zaman silik ya da hiç olmadığı özgün bir ortam oluşturur. Çocuklar şikayetlerini çoğunlukla ifade edemediğinden klinisyen, tanıya ulaşmak için ısrarcı göz ovma, fotofobi ve tekrarlayan kızarıklık gibi davranışsal ipuçlarına ve nesnel bulgulara dayanmak durumundadır. Tanının gecikmesi; görsel gelişimin kritik dönemlerinde ambliopi, geri dönüşü olmayan korneal skar ve kronik hastalığın biriken etkileri şeklinde somut maliyetler doğurmaktadır. Bu bölüm, vernal keratokonjonktivit, atopik keratokonjonktivit ve dev papiller konjonktivit dahil alerjik hastalıklar ile enfeksiyöz keratokonjonktivit, pediatrik blefarokeratokonjonktivit, flikteniüler keratokonjonktivit, oküler rozasea ve kuru göz hastalığının yanı sıra Stevens-Johnson sendromu ve oküler graft-versus-host hastalığının ciddi, görme tehdidi oluşturan sekellerini kapsayan pediatrik oküler yüzey hastalıklarının tüm spektrumunu ele almaktadır. Güncel tedavi stratejileri; konvansiyonel tedaviye yanıtsız çocuklarda erken immünomodülasyon, steroid koruyucu rejimler ve biyolojik ajanlar ile rejeneratif tıbbın gelişen rolüne vurgu yapılarak tartışılmaktadır.
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Referanslar
Douglas VP, Hall N, Ross C, et al. The epidemiology of pediatric dry eye disease in the United States: An IRIS® registry (Intelligent Research in Sight) analysis. Ocul Surf. 2024;32:106-111. doi:10.1016/j.jtos.2024.01.012
Borchman D, Foulks GN, Yappert MC, Milliner SE. Changes in Human Meibum Lipid Composition with Age Using Nuclear Magnetic Resonance Spectroscopy. Investigative Opthalmology & Visual Science. 2012;53(1):475. doi:10.1167/iovs.11-8341
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Cano-Suárez MT, Reinoso R, Martín MC, et al. Epithelial component and intraepithelial lymphocytes of conjunctiva-associated lymphoid tissue in healthy children. Histol Histopathol. 2021;36(12):1273-1283. doi:10.14670/HH-18-385
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Rohatgi J, Gupta VP, Mittal S, Faridi MMA. Onset and Pattern of Tear Secretions in Full-Term Neonates. Orbit. 2005;24(4):231-238. doi:10.1080/01676830500263208
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Yazdanpanah G, Bohm KJ, Hassan OM, et al. Management of Congenital Aniridia-Associated Keratopathy: Long-Term Outcomes from a Tertiary Referral Center. Am J Ophthalmol. 2020;210:8-18. doi:10.1016/j.ajo.2019.11.003
Baker M, Abedal-Kareem K, Eid S, et al. Ocular Manifestations in Congenital Insensitivity to Pain with Anhidrosis: A Window into a Rare Syndrome. Vision. 2025;9(3):62. doi:10.3390/vision9030062
Holland EJ., Mannis MJ., Lee WBarry. Ocular Surface Disease : Cornea, Conjunctiva and Tear Film. Elsevier/Saunders; 2013.
Niruthisard D, Fung SSM. Recombinant Human Nerve Growth Factor for Pediatric Neurotrophic Keratopathy. Eye & Contact Lens: Science & Clinical Practice. 2022;48(7):303-305. doi:10.1097/ICL.0000000000000912
Mahoney MJ, Bekibele R, Notermann SL, Reuter TG, Borman-Shoap EC. Pediatric Conjunctivitis: A Review of Clinical Manifestations, Diagnosis, and Management. Children. 2023;10(5):808. doi:10.3390/children10050808
Azari AA, Barney NP. Conjunctivitis. JAMA. 2013;310(16):1721. doi:10.1001/jama.2013.280318
de St. Maurice A, Tesini BL. Neonatal Conjunctivitis (Ophthalmia Neonatorum). 2025.
Wong VWY, Lai TYY, Chi SCC, Lam DSC. Pediatric Ocular Surface Infections: A 5-year Review of Demographics, Clinical Features, Risk Factors, Microbiological Results, and Treatment. Cornea. 2011;30(9):995-1002. doi:10.1097/ICO.0b013e31820770f4
Rasmussen MLR, D’Souza M, Topal DG, et al. Prevalence of allergic sensitization with vernal keratoconjunctivitis: A systematic review with meta-analyses. Acta Ophthalmol. 2023;101(1):9-21. doi:10.1111/aos.15212
Wu K, Yang Y. A Bibliometric Study on Research Trends and Characteristics of Pediatric Allergic Conjunctivitis. J Asthma Allergy. 2025;18:1297-1309. doi:10.2147/JAA.S541706
Tariq F. Allergic Conjunctivitis: Review of Current Types, Treatments, and Trends. Life (Basel). 2024;14(6). doi:10.3390/life14060650
Chigbu DI, Karbach NJ, Abu SL, Hehar NK. Cytokines in Allergic Conjunctivitis: Unraveling Their Pathophysiological Roles. 2024;14(3):350. doi:10.3390/life14030350
Berger WE, Granet DB, Kabat AG. Diagnosis and management of allergic conjunctivitis in pediatric patients. Allergy Asthma Proc. 2017;38(1):16-27. doi:10.2500/aap.2017.38.4003
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