Structural and functional outcomes of anaesthetic cornea in children.

Aim: To present visual and structural outcomes from the largest series to date of children with absent corneal sensation, and contribute recommendations for management.

Methods: A two-centre retrospective cohort of 33 eyes of 26 children was studied. Data regarding cause of corneal anaesthesia (CA), visual acuity (VA), complications and management were recorded.

Results: The most common underlying causes of CA were posterior fossa tumours (8), CA with somitic abnormalities (5), cerebellar hypoplasia (3), severe head trauma (3) and isolated CA (3). Median follow-up was 36½ months. Coexisting facial palsy was prevalent with 18 patients (69%) being affected. At final follow-up, 4/27 eyes (15%) with VA measures had VA 0.3 logMAR or better; 15/27 (56%) had VA 0.3-1.0 logMAR; and 8/27 (30%) had VA worse than 1.0 logMAR. Seven of eight eyes with final VA worse than 1.0 logMAR had coexisting facial palsy. Only one of these eyes with facial palsy had a permanent tarsorrhaphy before VA fell below 1.0 logMAR. Also, of the nine eyes with facial palsy and a best-recorded VA better than 1.0 logMAR at final follow-up, five had a permanent tarsorrhaphy. Corneal scarring was present in 24/33 (73%) of eyes by final follow-up. 15/33 (45%) had at least one episode of microbial keratitis. The first presentation was with this complication in 9/26 (35%) children.

Discussion: CA in children is a vision-threatening problem, which has a particularly poor prognosis when associated with facial nerve palsy. Earlier tarsorrhaphy should be considered to help preserve vision in eyes with CA and coexisting facial palsy.