Related Experiment Video
Updated: Apr 23, 2026
Author Spotlight: Establishing a Practical and Cost-Effective Protocol for Corneal Sensitivity Testing in Clinical Settings
Published on: August 2, 2024
Structural and functional outcomes of anaesthetic cornea in children
Rosemary G Lambley1, Naira Pereyra-Muñoz2, Manoj Parulekar3
1Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK Department of Ophthalmology and Vision Sciences, University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Children with absent corneal sensation (CA) face vision loss, especially when combined with facial palsy. Early surgical intervention, like tarsorrhaphy, may help preserve sight in these high-risk cases.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Neurology
Background:
- Absent corneal sensation (CA) in children is a rare but serious condition.
- The visual and structural outcomes, along with management strategies, for pediatric CA are not well-documented.
- Understanding the causes and complications is crucial for effective treatment.
Purpose of the Study:
- To report visual and structural outcomes in the largest series of pediatric patients with absent corneal sensation.
- To identify common causes and associated conditions, such as facial palsy.
- To provide evidence-based recommendations for managing pediatric CA.
Main Methods:
- A retrospective cohort study of 33 eyes from 26 children across two centers.
- Data collected included the cause of CA, visual acuity (VA), complications, and management interventions.
- Follow-up duration averaged 36.5 months.
Main Results:
- Posterior fossa tumors were the most frequent cause of CA.
- Facial palsy was present in 69% of patients.
- Significant visual impairment (worse than 1.0 logMAR) occurred in 30% of eyes, with a higher risk in those with facial palsy.
- Corneal scarring (73%) and microbial keratitis (45%) were common complications, with keratitis being the initial presentation in 35% of children.
Conclusions:
- Absent corneal sensation in children is a vision-threatening condition.
- The prognosis is particularly poor when CA is associated with facial nerve palsy.
- Consideration of earlier tarsorrhaphy is recommended to preserve vision in eyes with CA and concurrent facial palsy.
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.
Related Concept Videos
01:13Local Anesthetics: Pharmacokinetics
01:12Local Anesthetics: Adverse Effects
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
01:23Local Anesthetics: Common Agents and Their Applications
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...