Stromal Keratitis After Varicella in Children
Varicella is caused by the varicella-zoster virus (VZV), a member of the Herpesviridae family. It is a common, benign infantile viral disease that occurs mostly in children younger than 10 years of age and presents as a generalized pruriginous typical vesicular eruption and a low-grade fever. Here described that patients with stromal keratitis of chronic course, a potential manifestation after chickenpox in children. In a review of 8 eyes (7 children) with stromal keratitis after varicella is seen. All patients received systemic antiviral treatment with oral acyclovir and topical steroid eye drops. Topical cyclosporine eye drops were associated with steroids in case of steroid dependence or steroid-related side effects. Both anti-inflammatory treatments were slowly tapered over time

The median age at diagnosis was 3 years and 4 months. Stromal keratitis was unilateral in 6 children and consisted of superficial nummular keratitis in 4 cases and deep stromal diffuse keratitis in 3 cases. During the median follow-up of 31 months, 6 children had 1 to 6 episodes of relapse. The median duration of topical steroid eye drop was 26 months. Topical cyclosporine eye drops were used with steroids in 3 patients. Three patients stopped topical steroids after 2, 5, and 8 months, without recurrence. Four patients were still undergoing treatment after a median of 43 months. All patients regained a best-corrected visual acuity of 20/20 at the end of the follow-up.

Conclusively, Stromal keratitis after varicella is an entity with a potential chronic course lasting 3 months or more. Steroid dependence and relapses during tapering are 2 major challenges for the management. Stromal keratitis after varicella is an uncommon but potentially long-lasting chronic disease that occurs in a critical period of visual development for the child. Steroid dependence is a major challenge in management. In addition, relapses are barely symptomatic and can occur at any time during steroid tapering or after treatment discontinuation, which justifies prolonged patient follow-up. Adjunctive topical cyclosporine may be indicated in the treatment algorithm.