Spontaneous Corneal Perforation As The Presenting Sign Of Keratoconus In A 9-Year-Old Child

Keratoconus is a bilateral noninflammatory condition characterized by corneal steepening and thinning, which leads to a conical shape. Acute hydrops is a well-recognized complication of advanced keratoconus, estimated to occur in less than 3% of patients and associated with vigorous eye rubbing. We report a rare case of a nine-year-old child without ocular history who presented with spontaneous corneal perforation as a presenting sign of keratoconus. To the best of our knowledge, he is the youngest patient who presented with spontaneous corneal perforation due to acute hydrops in keratoconus.

Ophthalmology Department.

A nine-year-old boy presented with a one-day history of redness, photophobia, pain, and decreased vision in the right eye. On ocular examination, visual acuity was counting fingers in his right eye and 20/20 in his left eye. Slit lamp biomicroscopic examination of the right eye revealed an area of acute hydrops with corneal edema with a less than 1 mm central corneal perforation. He was known to have attention deficit hyperactivity disorder, and the parents noted that he tends to rub his eyes. A diagnosis of right acute hydrops with spontaneous corneal perforation was made. Corneal perforation was treated successfully with cyanoacrylate glue. The residual central corneal scar became gradually transparent with a best-corrected visual acuity of 20/50 after three years of follow-up. The patient also underwent corneal cross-linking in his left eye.

Spontaneous corneal perforation of acute hydrops due to keratoconus in children is rare but possible. As the recovery of the cornea and clearing of a corneal scar in children is sometimes very good, corneal transplantation may be avoided even in cases where perforation and resulting corneal scar are central.