Pediatric Ocular Surface Inflammatory Diseases: Clinical Features and Practice Patterns

Simon S M Fung; Tanya Boghosian; Claudia Perez; Fei Yu; Anne L Coleman; Lynn Gordon; Asim Ali; Stacy L Pineles

doi:10.1097/ICO.0000000000004030

Pediatric Ocular Surface Inflammatory Diseases: Clinical Features and Practice Patterns

Cornea. 2025 Nov 3. doi: 10.1097/ICO.0000000000004030. Online ahead of print.

Authors

Simon S M Fung¹, Tanya Boghosian², Claudia Perez³, Fei Yu^{4

5}, Anne L Coleman^{4

6}, Lynn Gordon⁵, Asim Ali^{7

8}, Stacy L Pineles⁵

Affiliations

¹ Department of Ophthalmology, University of California San Francisco, San Francisco, CA.
² Washington University in St. Louis School of Medicine, Missouri, Saint Louis.
³ Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
⁴ Department of Ophthalmology, University of California Los Angeles, Los Angeles, CA.
⁵ Departments of Biostatistics; and.
⁶ Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA.
⁷ Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada; and.
⁸ Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, ON, Canada.

PMID: 41198061
DOI: 10.1097/ICO.0000000000004030

Abstract

Purpose: To characterize nationwide real-world practice patterns and complications of pediatric ocular surface inflammatory diseases (POSID) using a large US health insurance claims database.

Methods: This retrospective cohort study analyzed patients younger than 18 years diagnosed with POSID in the Optum Labs Data Warehouse between 2018 and 2019. Blepharokeratoconjunctivitis (BKC), herpes simplex keratoconjunctivitis (HSK), and vernal keratoconjunctivitis (VKC) were identified by ICD codes. Clinical data from 6 months before to 3 years after the index visit were assessed. Multivariate logistic regression identified risk factors for amblyopia.

Results: Among 6116 children (67.1% aged 5-15 years; 56.6% male), HSK showed the highest baseline rates of corneal scarring (7.5%) and ulceration (5.5%), compared with BKC (2.3%, 2.7%) and VKC (1.1%, 0.9%) (P < 0.001). High-potency topical corticosteroids were more frequently prescribed for BKC (17.8%) than HSK (15.0%) or VKC (14.2%) (P = 0.02), while topical immunomodulators were used in only 1.7% of cases despite recommendations. Amblyopia prevalence rose from 2.5% to 4.5% over 3 years, with stromal scarring at diagnosis (odds ratio 2.43, 95% confidence interval 1.40-4.24) and high-potency corticosteroid use (odds ratio 1.60, 95% confidence interval 1.17-2.18) as independent risk factors.

Conclusions: POSID subtypes exhibit distinct clinical features, significant differences in management, and progressive complications over time. Nationwide patterns show over-reliance on corticosteroids, underuse of immunomodulators, and gaps between guideline recommendations and practice, underscoring the need for earlier recognition, steroid-sparing therapy, and sustained inflammation control.

Keywords: blepharokeratoconjunctivitis; herpes simplex keratitis; ocular surface disease; pediatric; vernal keratoconjunctivitis.