Risk factors, microbiological profiles, and clinical outcomes of paediatric infectious keratitis: The Midlands Infectious Keratitis Study

Abstract Objectives To characterise the clinical features, microbiological profiles, and outcomes of paediatric infectious keratitis (IK). Methods This retrospective multicentre study included paediatric patients (≤18 years old) who presented with presumed IK and underwent corneal sampling at two UK tertiary ophthalmic centres. Results We included 42 cases in this study; median age was 13.3 years (IQR 10.1–16.1). Contact lens wear (15, 35.7%) and ocular surface disease (15, 35.7%) were the most common risk factors. Twenty-five (59.5%) cases were microbiologically positive (MP), with Pseudomonas aeruginosa (5, 16.1%), Staphylococcus aureus (5, 16.1%), and Serratia marcescens (5, 16.1%) being the most commonly isolated bacteria. Six (24.0%) cases were caused by polymicrobial infection (≥2 bacteria). Median presenting CDVA was 0.30 logMAR [0.20–1.30] and improved to 0.15 [0.00–0.75] at final follow-up ( p < 0.001). Poor visual outcome (final CDVA > 0.6 logMAR) was observed in 11 (26.2%) cases and was associated with worse presenting CDVA ( p = 0.010), prior corneal surgery ( p = 0.003), and MP status ( p = 0.016). Delayed corneal healing (>30 days) occurred in 17 (40.5%) cases. Complications were uncommon, including 3 (7.1%) recurrence, 2 (4.8%) corneal melt, and 1 (2.4%) perforation. Conclusions Paediatric IK represents an important ocular morbidity in the UK. Contact lens wear was the most common risk factor and was strongly associated with P. aeruginosa infection, highlighting the need for improved awareness, education, and prevention. MP cases were associated with worse visual outcomes and features of greater disease severity. These findings support early recognition and appropriate management to optimise visual outcomes in this population.