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The Problem
“My child’s eye looks cloudy.”
Common Causes
Infantile glaucoma
Corneal infection
Forceps injury
Peter’s anomaly
Other Causes
Sclerocornea
Congenital corneal dystrophy
Mucopolysaccharidosis
Trauma
KEY FINDINGS
History
Infantile glaucoma
Eye appears larger than normal
Light sensitivity and excess tearing
Corneal infection
Most common in older children who wear contact lenses
Usually very uncomfortable
Possible trauma, foreign body
Forceps injury
Difficult delivery requiring forceps
Peter’s anomaly
Cloudy central cornea at birth
Other causes
May be associated with other systemic problems (e.g., mucopolysaccharidosis)
History of trauma
Examination
Infantile glaucoma
Enlarged cornea
Ground-glass appearance
Photophobia, excess tearing
Corneal infection
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
Later—oblique scars
Periocular and facial bruising and swelling from forceps
Peter’s anomaly
Central corneal clouding
Peripheral cornea usually clear
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Children with cloudy corneas should be referred promptly to a pediatric ophthalmologist.

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What Shouldn’t Be Missed

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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.

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  • 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 (Figure 16–4).
  • 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 develop.
  • 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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