Congenital Corneal Anomalies //
Corneal abnormalities in the newborn infant are reasonably uncommon. In some cases they may be visible at birth while in others it may be months or years before the changes are discovered. Many are minor and have little effect on the child’s visual function. Some are of only cosmetic significance.
Congenital (present at birth) problems are most easily discussed if one divides the different conditions into groups according to the nature of the problem. The following categories are commonly used for this purpose:
Abnormalities of ocular size
Abnormalities of corneal size
Abnormalities of corneal shape
Abnormalities of corneal transparency
Metabolic corneal opacities
Abnormalities of ocular and corneal size include such conditions as microphthalmos and microcornea (small eye or cornea) as well as megalophthalmos and megalocornea (large eye or cornea). Vision is usually dependent on the presence or absence of other eye problems.
Abnormalities of corneal shape include an unusually flat cornea (cornea plana), a steep cornea with or without associated iris abnormalities (corneal staphyloma), and a globular and thinned cornea (keratoglobus). These findings are often associated with other anomalies and have a high incidence of glaucoma.
Abnormalities of corneal transparency have the most dramatic presentation since they are often associated with a white, opaque cornea. This group of conditions includes Peters Anomaly, sclerocornea, intrauterine corneal ulceration, tears in Descemets’ Membrane, and a number of metabolic disorders.
The initial approach to most congenital corneal anomalies involves a thorough ocular and systemic history and examination. Many of the conditions mentioned above may be associated with other ocular or systemic problems. A thorough ocular examination of a newborn or young child will usually include a sedated examination – referred to as an examination under anesthesia (EUA). This will usually take place in an operating room due to the availability of good pediatric anesthesia. When all studies have been completed (the EUA as well as other specialized testing) this information will be evaluated and a medical or surgical treatment plan formulated. We will sit down with you to go over the treatment options and ultimately communicate this information to your referring ophthalmologist and pediatrician.