Spontaneous corneal perforation in premature infants

Spontaneous corneal perforation in premature infants not due to birth trauma is a rare event, with only 8 cases reported in the literature. We recently encountered a case of spontaneous corneal perforation in an extremely premature infant born at 26 weeks of gestation. The mechanism leading to this event was corneal exposure resulting in corneal epithelial defect. Clinical evidence of secondary infection ensued and this led to cornea thinning, descemetocoele formation and subsequent perforation with extrusion of intraocular contents. Although other mechanisms were responsible in the previously reported cases, we feel that exposure keratopathy leading to this complication poses a potential hazard to all premature infants. An awareness among care givers of this potential complication together with avoidance of exposure keratopathy in this group of patients is paramount in preventing this visually catastrophic event.