The necessity for ocular assessment in atopic children: bilateral corneal hydrops in an 8 year old

Acute corneal hydrops is a rare complication of advanced corneal ectasia. This case report describes the clinical course of a child with severe atopy and no previous ocular examination who developed bilateral, acute corneal hydrops, secondary to keratoconus, by 8 years of age. The report demonstrates the rapidity of progression in the pediatric phenotype of the disease. This case also provides an important clinical lesson in highlighting the necessity for children with atopy to be referred for comprehensive ophthalmic examination, even in the apparent absence of visual symptoms, to ensure the timely diagnosis and management of any atopy-associated ocular disease. Prompt referral is particularly essential for pediatric corneal ectasia, in which the rapidity of progression may preclude stabilizing treatments, such as corneal collagen cross-linking, and result in significant childhood visual impairment, as was the case for this child. This case demonstrates the potential for significant ocular involvement in atopic children and identifies scope to enhance current international clinical guidelines relating to the management of childhood atopy through the inclusion of ocular screening for associated disease.