Pediatric Keratokonus

To report the case of a pediatric patient with bilateral keratoconus age 9 years old. Pediatric keratoconus (pediatric KC) causes progressive deformation of the cornea in children and adolescents, leading to a gradual loss of vision and a need for rehabilitation. However, new treatments such as CXL may halt the disease and prevent worse outcomes that require penetrating keratoplasty and its associated morbidity and high cost and irreversible loss of vision.

A literature search was done on PubMed using key words including pediatric keratoconus, children with keratoconus, adult keratoconus, penetrating keratoplasty, corneal cross-linkingThe literature was reviewed and reported to explore the key epidemiological differences between the pediatric and adult population, the genetic and hormonal factors as key factors affecting  early disease at pediatric age.

A 9-year-old male from Tirana  presented to the Focus Eye Clinic with a 1  year history of progressively worsening vision in his left eye (OS) more than his right eye (OD) and chronic allergic conjunctivitis. He is otherwise healthy with no medical problems and takes no systemic or ocular medications. He has no family history of Keratokonus. He is orthophoric at distance and near. His best corrected vision with spectacles is 10/10 OD and 9/10 OS with a refractive error of -1.50 - 2.50 x 25 OD and -3.5 - 3.5  x 120 OS. His posterior segment examination was within normal limits. Corneal topography was consistent with keratoconus OU. OD stage 1, thinnest location 486 µm K max 47.5 D  and OS stage 2, thinnest location 462 µm K max 48.8 D.  I performed CXL both eyes one month after diagnosis November 2024. He is followed by corneal topography every 4- 6 months an the vision is corrected with glasses.

Keratoconus early detection and final diagnosis require a complete eye exam and in-depth corneal assessment. In our clinic it’s the first case at this age with both eyes with keratoconus. This case shows that we should start screening early maybe from 8 years old since the corneal topography doesn’t have any side effect, and is the best tool for keratoconus diagnosis and management. Also the change in growth rate of the new generations and hormonal factors may contribute in greater incidence of pediatric keratoconus in the last years also in our country. Early detection is of paramount importance in primary eye care, and if treated early with CXL we can preserve vision and use less hard CL and corneal tranplants in the future.