VOGT-KOYANAGI-HARADA SYNDROME IN CHILDREN

Purpose: To describe the clinical presentation and natural history of Vogt-Koyanagi-Harada (VKH) syndrome in children, an often unrecognized cause of pediatric uveitis. Methods: We performed a clinic-based cros s-sectional survey and retrospective review of pediatric patients with VHK seen in the uveitis clinic at the Aravind Eye Hospital, Madurai, India, between January 1993 and December 1995. Results: A total of 98 patients with VKH syndrome were seen in the uveitis clinic at the Arav ind Eye Hospital during the three years covered by the survey, of whom three (about 3%, with an approximate incidence of I case/year) were c hildren 16 years of age or younger. Initial symptoms included eye pain , redness, and blurred vision in all three patients. Headache and dysa cusis accompanied the onset of visual symptoms in one patient. Each pa tient eventually developed areas of vitiligo and poliosis, although th ese signs were not present at the time of presentation in any of our p atients. Signs of active uveitis included anterior chamber and vitreou s inflammation, optic disc edema, exudative retinal detachments, and D alen-Fuchs'-like nodules. All three patients developed cataracts, two developed retinal pigment epithelium atrophy, and one developed glauco ma. Each patient responded well, with good visual recovery, to topical and/or systemic corticosteriods. Conclusions: Although frequently unr ecognized, VKH syndrome may affect children. As with adults, visual lo ss occurs most typically as the result of cataract, glaucoma, or retin al pigment epithelium atrophy.