Paediatric Cornea – Corneal Opacification, Cloudy Cornea

 in Children

The cornea is the dome-shaped transparent anterior part of the eyeball.  The cornea acts like the window that allows light to enter the eye. It also focuses the light on the retina that has the photoreceptors.  Corneal opacities block the light from going to the eye and can cause severe vision loss. Moreover, children can develop amblyopia if they have unclear vision during their visual development and timely visual rehabilitation is not provided. Amblyopia can worsen the prognosis of treatment.

Causes

There are many causes of acquired corneal opacity, such as following infection, inflammation, and eye injury. However, it can be congenital such as in Peters anomaly, corneal dystrophies, congenital glaucoma, forceps injury during birth, scar post corneal hydrops, or apical scar in keratoconus, and some metabolic diseases.

Symptoms

If your child encounters any of these symptoms, do not assume it is due to corneal opacity. These symptoms may be caused by other eye conditions as well. 

• Cloudy area on the cornea
• Blurred vision
• Vision loss
• Tearing
• Seeing “halos” around lights
• Irritation, foreign object sensation
• Sensitive to light
• Eye pain
• Discharge

Tests

Comprehensive eye exam:

 A thorough eye exam is the first step in diagnosing this condition. Your eye doctor may put drops in your child’s eyes to numb and dilate the pupils. An examination under anaesthesia may be needed to thoroughly examine some infants and young children. Your eye doctor may contact your paediatrician for the systemic association in certain diseases. 

Slit Lamp Examination: 

With this tool, your eye doctor evaluates the characteristic and extent of corneal opacity. 

Treatments

Your eye doctor will discuss the best treatment plans for your child. Treatment varies depending on the cause, extent and severity of the opacity. Some types of corneal opacity can be lessened with time, such as after corneal infection and inflammation, but some remain the same and require additional treatment. 

Non-surgical treatment

• Eye drops
• Oral medications
• Eye glasses or contact lens

Surgical treatment 

• Phototherapeutic keratectomy (PTK) is a laser surgery to remove scar tissue. 
• Optical sectoral iridectomy creates an opening in the colour part of the eye (iris). This surgery allows light to bypass the area with corneal opacity. It is an option in cases in whom corneal transplantation (keratoplasty) is not recommended.
• Corneal transplantation may be necessary in more severe cases.