There are very few published cases of periocular keratin horns that have been reported in children. This study reports 2 pediatric cases of periocular keratin horns. The authors describe a 7-year-old male child who developed a keratin horn on the right lower eyelid and a 16-year-old female who developed a caruncular keratin horn. Both cases underwent excision biopsy, and subsequent histology confirmed that there was no evidence of malignancy. However, on the basis of the current evidence in adults and the difficulty in drawing firm conclusions from the small number of reported pediatric cases, the authors suggest that these lesions should be carefully managed due to the possibility of premalignant or malignant change at the base of the lesion.