|“My child’s eye looks cloudy.”|
|Congenital corneal dystrophy|
|Eye appears larger than normal|
|Light sensitivity and excess tearing|
|Most common in older children who wear contact
|Usually very uncomfortable|
|Possible trauma, foreign body|
|Difficult delivery requiring forceps|
|Cloudy central cornea at birth|
|May be associated with other systemic problems
|History of trauma|
|Photophobia, excess tearing|
|Focal areas of increased corneal clouding|
|Possible corneal foreign body|
|Eye appears bloodshot (conjunctival injection)|
|Corneal dendrites (herpes simplex virus infection)|
|Corneal forceps injury|
|Cornea initially usually diffusely cloudy|
|Periocular and facial bruising and swelling
|Central corneal clouding|
|Peripheral cornea usually clear|
Children with cloudy corneas should be referred promptly to a
Corneal infections require prompt
treatment to minimize the risk of corneal ulcer and permanent visual
damage. Infants with cloudy corneas are at high risk for amblyopia
(similar to infants with cataracts), and early treatment may greatly
improve the prognosis.
- 1. Infantile glaucoma. Glaucoma
results from increased intraocular pressure. In infants and young
children with glaucoma, the pressure may cause abnormal growth of
the eye. The affected eye(s) appears larger than normal (Figure
16–1). The pressure interferes with the normal mechanisms
that keep the cornea clear, and the cornea often has a ground-glass
appearance. Haab striae (curvilinear scars in the corneal endothelium)
may develop (Figure 16–2).
- 2. Corneal infections. Corneal
infections are a potentially serious problem that may result in
permanent visual loss. Bacterial infections are usually associated
with a foreign body, either accidental or from contact lenses. (Figure
16–3). Herpes simplex virus may also affect the cornea
- 3. Forceps injury. Forceps may
be used by obstetricians during difficult deliveries. If the forceps
produce direct pressure on the eye, children may develop traumatic
opacification of the cornea. The opacification usually improves,
but patients often have residual scarring and high astigmatism (Figure
16–5). They are at risk for deprivation amblyopia.
- 4. Peter’s anomaly. Peter’s
anomaly is a congenital corneal abnormality that presents with
opacification of the central cornea (Figure 16–6). The
peripheral cornea is usually clear. Glaucoma and cataracts may also
- 5. Other. Several other rare
disorders may cause corneal clouding, including sclerocornea, congenital
corneal dystrophies (Figure 16–7), and mucopolysaccharidosis
(Figure 16–8). Cystinosis does not cause clouding per se,
but patients usually have progressive crystalline deposits in their
corneas, which cause light sensitivity (Figure 16–9). Trauma
in older children may cause corneal foreign bodies, lacerations,
and corneal edema (Figure 16–10).
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