The anesthetic cornea and exposure keratopathy in infants and children

Corneal anesthesia and exposure keratopathy are important and often overlooked causes of visual loss in infants and children. Corneal anesthesia may be congenital or acquired, and exposure keratopathy may be secondary to corneal anesthesia or mechanical eyelid abnormalities. The evaluation of any child with corneal anesthesia and exposure keratopathy should begin with a careful history seeking to determine the etiology of the condition. The exam should focus on eyelid position, and health of the conjunctival and corneal surfaces. Treatment depends on the underlying etiology, and can be approached in a step-wise fashion depending on the severity of corneal involvement. Active corneal ulceration should be treated aggressively in order to prevent progression of disease, perforation, and loss of vision. Treatment of pediatric corneal anesthesia and exposure keratopathy may be continued for life; however, with careful attention to the integrity and health of the ocular surface, the long-term prognosis may be quite good.