PAEDIATRIC CORNEAL CONDITIONS

The cornea is a small transparent structure in the eye which contributes significantly to the clarity of vision. This is in fact known as ‘apple of the eye’. This tiny structure could be affected by various diseases, some of those are congenital and inherited whereas others could be acquired.

Common Corneal Conditions in Children

Corneal opacity, infections, corneal tear, corneal dystrophies (abnormal deposits within the layers of the cornea), corneal ectasia (change in the shape of the original structure) are some of the conditions affecting the Cornea.

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

Common Symptoms Associated with Corneal Problems in Children

In most of the corneal problems, symptoms are obvious and can be seen with the naked eyes. However, some conditions may be present even without an apparent symptom. Infants, unlike adults, cannot express their symptomatic difficulty, such as a blurring vision. But there could still be some obvious indication that could direct us to the underlying condition.

• Cloudy area on the cornea
• Blurred vision
• Vision loss
• Tearing
• Seeing “halos” around lights
• Irritation, foreign object sensation
• Sensitive to light
• Eye pain
• Discharge
•  redness and watering of eyes
• constant rubbing of the eyes.
• whitish appearance or whitish spots on the black portion of the eyes

One of the very common causes that damage cornea is an injury. Children use sharp pencils or pens or some children even play with sharp instruments which could critically injure the cornea.

Diagnosis of Corneal Conditions

A detailed eye examination by a paediatric ophthalmologist using a microscope will reveal these problems. In some cases, corneal topography and optical coherence tomography may be warranted.

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. 

Treatment of Corneal Conditions

Corneal infections may be treated with eye drops or tablets. In some cases, glasses or contact lenses may be prescribed. In the cases where the transparency of the cornea is affected, surgical procedures such as complete or partial corneal transplant may be needed.

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.