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Children's Hospital Boston now offers comprehensive evaluation and management of pediatric corneal and ocular surface diseases. The cornea is the clear front window of the eye. One of its main functions is to focus light rays coming into the eye to allow clear vision. The conjunctiva (the clear covering of the white part of the eye) and the inside of the eyelids make up the ocular surface. The ocular surface serves to protect the eye and keep it comfortable by creating and maintaining the tear layer.
There are many diseases of the cornea that afflict children. Some of the same conditions occur in adults as well, although a number are unique to children.Corneal infections are common. These can be caused by bacteria (most often associated with contact lens use), viruses (including the "cold sore" virus, known as herpes simplex), and other less common types of organisms. Corneal infections are serious, but when properly diagnosed and managed, outcomes can be good.
Another class of corneal diseases that affects children has to do with changes in the shape of the cornea. The most common of these conditions is keratoconus, where the cornea assumes a cone-like shape. Vision is reduced in keratoconus because the abnormally-shaped cornea does not focus the incoming light rays accurately.
Occasionally in children the cornea is hazy rather than being clear. Sometimes this is noted at birth, while in other cases the hazy develops over time. The haze in the cornea can reduce vision because it prevents light rays from passing through the cornea. The treatment for corneal opacities in children may involve transplantation of a healthy cornea from a donor into the child?s eye. This is called a corneal transplant. In the United States, about 35,000 corneal transplants are done each year, although most of these are performed in adult patients. Corneal transplantation is a successful operation, but visual recovery is slow (6-12 months) due to irregularities in the shape of the transplant (astigmatism) and the corneal transplant can be rejected by a patient?s body because it is a piece of foreign tissue.
A new approach for treatment of corneal opacities in children involves the placement of an artificial (plastic) cornea, which is called a keratoprosthesis. Developed in Boston, this device improves visual acuity very rapidly after the surgery, because there is no astigmatism. In addition, the body cannot reject the keratoprosthesis because it is plastic. This is an exciting advance in the treatment of pediatric corneal diseases.
Conditions of the ocular surface can occur in children. Common ones are dry eye (when the eye doesn?t make enough tears or the tears evaporate too quickly) and allergic eye disease. Many eye allergies are not severe (such as itchy runny eyes that occur during allergy season). However, some eye allergies can produce corneal scarring and vision loss. When properly diagnosed and treated, even the severe allergies can be controlled in most cases. Finally, children can have growths on the surface of the eye. These growths are usually benign, but can mimic conjunctivitis and can be a cause of great concern for parents and pediatricians.
At Children's Hospital, Dr. Kathryn Colby, our cornea specialist, has extensive experience in all aspects of pediatric corneal and external diseases.
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