Pediatric Ocular Surface Inflammatory Diseases: Clinical Features and Practice Patterns.

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.