Age-related differences in the clinical and microbiological profile of pediatric microbial keratitis in Eastern India

PURPOSE: To evaluate the demographics, predisposing factors, microbiological profile, management, and outcomes of pediatric microbial keratitis in Eastern India, with particular emphasis on age-related differences. MATERIALS AND METHODS: This prospective study included children with clinically diagnosed microbial keratitis between April 2024 and September 2025. Clinical, microbiological, nutritional, treatment, and outcome data were recorded. Children were categorized into two age groups: ≤ 5 years and >5 years for comparative analysis. RESULTS: Ninety-nine eyes of 86 children were analyzed. The mean age was 5.9 ± 4.8 years, and 42 of 86 children were aged ≤5 years. Bilateral keratitis was observed exclusively in children ≤5 years (p < 0.05). Systemic risk factors such as undernutrition and vitamin A deficiency, diarrhea, and fever were significantly more common in children ≤5 years; in contrast, corneal injury was the predominant risk factor in children >5 years. Mean duration of presentation, ulcer size, and ulcer severity did not differ significantly between the two age groups, although perforation at presentation was more frequent in children >5 years. Fungal keratitis was significantly more common in children >5 years, whereas unidentified cases were more frequent in ≤5 years. Corneal ulcers resolved with medical therapy alone in 59.6% of eyes. Surgery was required in 40.4% of eyes overall, including 18.2% of eyes in children ≤5 years and 22.2% in children >5 years. At 3 months, corneal opacity was the most common outcome. CONCLUSION: Pediatric microbial keratitis showed clear age-related differences. Younger children were more often affected by systemic and nutritional vulnerability with predominantly sterile or bacterial keratitis, whereas older children had more trauma-related and fungal disease. Early referral, improved nutritional support, and timely globe-preserving management may reduce visual loss. CONFERENCE PRESENTATION: This research work has been selected for presentation at ARVO 2026, Denver, Colo. May 3 - 7.