The study was registered as a service evaluation. We reviewed the medical records of Fifteen children prescribed OCS (prednisolone 1 mg/kg for three days) for VKC/AKC between 2008 and 2018, noting age, gender, severity of corneal epithelial disease (modified Cameron [1]), and outcome including the proportion of ulcers healed within 2 weeks of starting OCS, proportion requiring surgical intervention, and time between starting OCS and re-epithelialisation. In children prescribed OCS on multiple occasions, these were included as distinct episodes, resulting in 30 interventions.

The median age at diagnosis was 11 years (IQR 9–14). All but one patient were boys (94%). Indications for OCS were as follows: the presence of ulceration or severe punctate corneal epitheliopathy indicative of imminent ulceration; to control inflammation before and after lamellar keratectomy. Twelve interventions (40%) involved grade 3 lesions (Fig.1). Of these, OCS was supplementary to superficial keratectomy in 7 (58%), with early re-epithelialisation in all cases. In the five who did not have early keratectomy, two resolved with OCS alone but two eventually required keratectomies (48 and 63 days after starting OCS). One was lost to follow-up. Four cases (13%) involved grade 2 lesions. Two re-epithelialised within 14 and 28 days but two required superficial keratectomy four weeks after starting OCS. Ten interventions (33%) involved stage 1 lesions, of which six re-epithelialised within 14 days, one within 22 days, and three were lost to follow-up. Four cases (13%) received OCS for pre-stage-1 lesions, with the epithelium stabilising within 14 days. No child suffered adverse events from OCS.

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