Last Updated: 2 September, 2025
Keratoconus is a progressive eye condition that affects the cornea, causing it to thin and bulge into a cone-like shape. While it primarily affects teenagers and young adults, paediatric keratoconus (in children) is less common but still poses significant challenges for early detection and treatment. Early intervention is key to preventing vision loss and ensuring the best possible quality of life for children affected by this condition.
In this blog, we’ll explore the early signs of paediatric keratoconus, discuss its potential causes, and outline the treatments available to manage and treat this condition.
What is paediatric keratoconus?
Keratoconus occurs when the normally spherical cornea gradually becomes thinner and more conical. This change in shape distorts light entering the eye, leading to blurred or distorted vision. When the condition develops in children, it can progress quickly, making it essential for parents and healthcare providers to identify it early.
Early signs of paediatric keratoconus:
The earlier keratoconus is diagnosed, the better the chances of effective management. Since the condition often starts in childhood, here are some early warning signs that parents should watch for:
- Blurred or Distorted vision: One of the earliest and most noticeable signs is a decrease in visual clarity. Children may report that their vision is blurry, even after using glasses or contact lenses. This is often due to irregularities in the cornea’s shape.
- Frequent prescription changes: Children with keratoconus may experience frequent changes in their eyeglass prescription as the cornea changes shape. If a child’s prescription changes rapidly, it may indicate an underlying issue such as keratoconus.
- Squinting or Frequent eye rubbing: Squinting or rubbing eyes more than usual may signal discomfort or blurry vision. The act of rubbing eyes may further contribute to worsening the condition, as it can increase corneal thinning.
- Sensitivity to light (Photophobia): Children may become more sensitive to bright lights, even to the point of experiencing headaches or discomfort in well-lit environments. This is common in keratoconus due to the irregular curvature of the cornea.
- Halos or Starbursts around lights: Nighttime vision may be significantly affected, causing halos or starburst-like effects around lights. This occurs because of the distorted corneal shape, which alters how light enters the eye.
- Frequent eye fatigue: Children may complain of tired eyes, especially after extended reading, screen time, or focusing on activities requiring close vision. This can be due to the eye’s struggle to focus properly due to keratoconus.
- Sudden or Gradual vision loss: As the condition progresses, children may experience a more noticeable loss of vision, even with corrective lenses. If left untreated, keratoconus can lead to significant vision impairment.
Causes of paediatric keratoconus:
While the exact cause of keratoconus is still not fully understood, certain factors may increase the risk of developing this condition in children:
- Genetic factors: A family history of keratoconus increases the likelihood of a child developing the condition. Children of parents with keratoconus are more likely to be affected.
- Environmental factors: Eye rubbing, which may be a result of allergies or irritation, has been linked to the development or worsening of keratoconus. Allergic conditions like asthma or eczema can contribute to frequent eye rubbing.
- Hormonal changes: Puberty is a time of rapid physical change, and it is believed that hormonal shifts during this period may contribute to the development of keratoconus.
- Other eye conditions: Children with certain eye conditions, like Down syndrome, Marfan syndrome, or Ehlers-Danlos syndrome, may have a higher risk of developing keratoconus.
Diagnosing paediatric keratoconus:
A comprehensive eye exam conducted by an ophthalmologist is essential for diagnosing keratoconus. Common diagnostic tools include:
- Corneal topography: This test creates a detailed map of the cornea’s shape and curvature. It can detect early signs of keratoconus by showing irregularities in the corneal surface.
- Pachymetry: This test measures the thickness of the cornea, which can reveal the thinning characteristic of keratoconus.
- Slit-Lamp examination: This is a standard test in which the eye doctor examines the cornea under high magnification to check for abnormalities.
Treatment options for paediatric keratoconus:
While keratoconus cannot be cured, various treatments can manage the condition, especially when detected early.
- Eyeglasses or Soft contact lenses: In the early stages of keratoconus, vision can often be corrected with eyeglasses or soft contact lenses. These provide a temporary solution, but as the condition progresses, specialised contact lenses may be necessary.
- Rigid Gas Permeable (RGP) contact lenses: RGP lenses are a common treatment for keratoconus as they can help to improve vision by providing a smoother surface over the irregular cornea. They can be more comfortable and effective than traditional soft lenses.
- Corneal Cross-Linking (CXL): Cross-linking is a non-invasive treatment that strengthens the corneal tissue to prevent further progression of the condition. This procedure uses ultraviolet light and riboflavin (vitamin B2) to strengthen the bonds in the cornea, making it more rigid and less prone to further bulging.
- Corneal transplant surgery: In more advanced stages of keratoconus, when other treatments are no longer effective, a corneal transplant may be required. The damaged cornea is replaced with a healthy donor cornea to restore vision.
- Topography-Guided Photorefractive Keratectomy (PRK): In some cases, a laser treatment known as PRK can be used to reshape the cornea, improving vision and correcting irregularities.
Conclusion
Paediatric keratoconus is a rare but serious condition that can significantly affect a child’s vision. Early detection and intervention are crucial in managing the disease and preserving eyesight. Parents should be vigilant in watching for the signs of keratoconus and seek consultation with an ophthalmologist if any symptoms arise.
Author bio
Dr Parth Shah is an experienced ophthalmologist in Canberra, Australia. With extensive training and experience, he is renowned for his expertise in the field. Dr Shah is dedicated not only to performing successful surgeries but also to patient education. His compassionate approach, combined with technical proficiency, has earned him the trust and gratitude of countless patients. He is a true advocate for eye health and a trusted name in the Canberra ophthalmology community.
FAQs
Yes, there is a genetic component to keratoconus. If a child has a family member with the condition, they may have a higher risk of developing it.
Paediatric keratoconus typically begins during the teenage years, but it can also start earlier in childhood. Early diagnosis is key to effective treatment.
Children with keratoconus can still participate in sports, but they should be cautious and consult an ophthalmologist about protective eyewear to avoid eye injury.
Keratoconus can cause blurred or distorted vision, which may affect reading, writing, and screen-based activities, potentially impacting school performance. Early intervention and appropriate corrective lenses can help.
While paediatric keratoconus cannot be prevented, minimising eye rubbing and managing allergies can reduce the risk of progression. Regular eye exams can help with early detection.
If left untreated, paediatric keratoconus can progress and lead to severe vision impairment or blindness due to the cornea becoming increasingly misshapen and thin.
With early detection and appropriate treatment, many children with keratoconus can maintain good vision and prevent severe complications. Regular follow-ups with an ophthalmologist are essential for monitoring the condition.
