Queratitis herpética estromal intersticial pediátrica: reporte de caso Pediatric interstitial stromal herpetitis: case report

ABSTRACT Pediatric stromal herpetic keratitis is a significant clinical issue; misdiagnosis and the empirical use of topical corticosteroids exacerbate the condition, increasing the risk of irreversible corneal sequelae and amblyopia. The objective was to describe the clinical presentation, course, and successful medical management of a case of interstitial stromal herpetic keratitis in a school-aged patient. A qualitative, descriptive, observational study was conducted using a retrospective case report design involving a 7-year-old male patient treated at the Ophthalmology Department of the Central Hospital of San Cristóbal, Venezuela. Data collection involved a review of medical records, visual acuity measurement, and slit-lamp biomicroscopy. Initially, the patient presented with a visual acuity of 20/50 in the left eye, an epithelial lesion, and a stromal infiltrate, a condition aggravated by prior steroid use without antiviral coverage. Steroid use was discontinued, and intensive antiviral therapy was initiated; on the eighth day, a Wessely immune ring became evident, confirming the stromal immunological pathophysiology and allowing for the controlled reintroduction of topical corticosteroids. Complete resolution of the condition was achieved after 48 days, restoring corneal transparency and resulting in 20/20 vision. It is concluded that identifying clinical signs such as the Wessely ring is crucial, and that a stepwise therapeutic approach prioritizing viral control before immunomodulation, is the safest and most effective strategy for preventing irreversible complications and ensuring pediatric visual health.