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| The Problem |
| “My child’s eye looks cloudy.” |
| Common Causes |
| Infantile glaucoma |
| Corneal infection |
| Forceps injury |
| Peter’s anomaly |
| Other Causes |
| Sclerocornea |
| Congenital corneal dystrophy |
| Mucopolysaccharidosis |
| Trauma |
| KEY FINDINGS |
| History |
| Infantile glaucoma |
| Eye appears larger than normal |
| Light sensitivity and excess tearing |
| Corneal infection |
| Most common in older children who wear contact lenses |
| Usually very uncomfortable |
| Possible trauma, foreign body |
| Forceps injury |
| Difficult delivery requiring forceps |
| Peter’s anomaly |
| Cloudy central cornea at birth |
| Other causes |
| May be associated with other systemic problems (e.g., mucopolysaccharidosis) |
| History of trauma |
| Examination |
| Infantile glaucoma |
| Enlarged cornea |
| Ground-glass appearance |
| Photophobia, excess tearing |
| Corneal infection |
| Focal areas of increased corneal clouding |
| Possible corneal foreign body |
| Eye appears bloodshot (conjunctival injection) |
| Corneal dendrites (herpes simplex virus infection) |
| Corneal forceps injury |
| Cornea initially usually diffusely cloudy |
| Later—oblique scars |
| Periocular and facial bruising and swelling from forceps |
| Peter’s anomaly |
| Central corneal clouding |
| Peripheral cornea usually clear |
- 1. Infantile glaucoma. Glaucoma results from increased intraocular pressure. In infants and young children with glaucoma, the pressure may cause abnormal growth of the eye. The affected eye(s) appears larger than normal (Figure 16–1). The pressure interferes with the normal mechanisms that keep the cornea clear, and the cornea often has a ground-glass appearance. Haab striae (curvilinear scars in the corneal endothelium) may develop (Figure 16–2).
- 2. Corneal infections. Corneal infections are a potentially serious problem that may result in permanent visual loss. Bacterial infections are usually associated with a foreign body, either accidental or from contact lenses. (Figure 16–3). Herpes simplex virus may also affect the cornea (Figure 16–4).
- 3. Forceps injury. Forceps may be used by obstetricians during difficult deliveries. If the forceps produce direct pressure on the eye, children may develop traumatic opacification of the cornea. The opacification usually improves, but patients often have residual scarring and high astigmatism (Figure 16–5). They are at risk for deprivation amblyopia.
- 4. Peter’s anomaly. Peter’s anomaly is a congenital corneal abnormality that presents with opacification of the central cornea (Figure 16–6). The peripheral cornea is usually clear. Glaucoma and cataracts may also develop.
- 5. Other. Several other rare disorders may cause corneal clouding, including sclerocornea, congenital corneal dystrophies (Figure 16–7), and mucopolysaccharidosis (Figure 16–8). Cystinosis does not cause clouding per se, but patients usually have progressive crystalline deposits in their corneas, which cause light sensitivity (Figure 16–9). Trauma in older children may cause corneal foreign bodies, lacerations, and corneal edema (Figure 16–10).
