title: Structural and functional outcomes of anaesthetic cornea in children.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department 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.
authors.forename: Rosemary G
authors.initials: RG
authors.lastname: Lambley
authors.affiliation: Department of Ophthalmology and Vision Sciences, University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada Departamento de Oftalmología Pediátrica, Hospital Starmédica Infantil Privado, Mexico City, Mexico.
authors.forename: Naira
authors.initials: N
authors.lastname: Pereyra-Muñoz
authors.affiliation: Department of Ophthalmology, Birmingham Children's Hospital, Birmingham, UK.
authors.forename: Manoj
authors.initials: M
authors.lastname: Parulekar
authors.affiliation: Department of Ophthalmology and Vision Sciences, University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Kamiar
authors.initials: K
authors.lastname: Mireskandari
authors.affiliation: Department of Ophthalmology and Vision Sciences, University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Asim
authors.initials: A
authors.lastname: Ali
mesh_terms: D000650:Amnion / Q000637:transplantation; D002648:Child; D002675:Child, Preschool; D003315:Cornea / Q000503:physiopathology*; D003316:Corneal Diseases / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000503:physiopathology* / Q000601:surgery; D007223:Infant; D015948:Keratoplasty, Penetrating; D008297:Male; D012189:Retrospective Studies; D014786:Vision Disorders / Q000503:physiopathology*; D014792:Visual Acuity / Q000502:physiology*
keywords: Child health (paediatrics); Cornea; Ocular surface