Corneal, conjunctival, and external eye diseases and injuries in children


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Abstract

Many conditions and diseases of the ocular anterior segment are unique to children or are first manifest in childhood. Keratoconus is probably more pervasive as an inherited disease than we have realized. New technology, such as computerized corneal mapping of keratoconus, allows more sensitive documentation of hereditary patterns with variable expression. Although rare, the corneal crystallization of nephropathic cystinosis can be halted and even reversed with topical cysteamine drops. The presence of Bitot's spots on the conjunctiva does not always suggest a current vitamin A deficiency but does show a chronic deficiency in the past that has caused an irreversible squamous metaplasia. Accidental blows, falls, and car crashes cause more than 95% of ocular trauma in children under 5 years of age. Sports-related injuries cause the greatest amount of ocular trauma in 11− to 15-year-old children. Most pediatric eye injuries are preventable. Corneal transplantation in children still falls far short of equaling the success seen in adults. A clear relationship exists between the age of the recipient and the clarity of the graft, with older children doing much better. Many corneal surgeons avoid early transplantation of monocular congenital corneal opacities because of the very poor prognosis, even though early is when surgery should be done.

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