Author's details
Reviewer's details
Corneal Opacities in Children: A Nigerian Perspective
Corneal opacity is one of the leading causes of childhood blindness in Nigeria and other developing countries. The cornea is a transparent tissue that plays a critical role in focusing light onto the retina. Any scarring or opacity in the cornea leads to impaired vision, which may be severe and irreversible.
In developed countries, corneal opacities in children are often addressed with keratoplasty (corneal transplant), but in Nigeria, this is rarely feasible due to the absence of cornea banks. Cultural beliefs against eye donation have hindered the establishment of sustainable corneal transplant services.
At ECWA Eye Hospital, Kano, the common causes of corneal opacity in children include measles keratitis, harmful traditional eye medications (used for conjunctivitis and other minor eye complaints), trauma, vitamin A deficiency, and ophthalmia neonatorum. These are preventable causes, yet they continue to affect many children who eventually present with profound visual impairment.
Symptoms
- Reduced or complete loss of vision.
- White or grayish discoloration of the cornea noticed by parents.
- Abnormal visual behavior (e.g., bumping into objects, poor fixation).
- Cosmetic concerns due to a visible corneal scar.
- Associated photophobia or tearing in some cases.
Clinical Findings
- Central or paracentral corneal scar or opacity.
- Irregular corneal surface and vascularization in chronic cases.
- Reduced visual acuity, especially if opacity involves the visual axis.
- Associated complications such as amblyopia or strabismus in children.
Differential Diagnoses
- Congenital hereditary corneal dystrophies.
- Congenital glaucoma (with corneal haze).
- Leukocoria from retinoblastoma or cataract.
- Keratoconus with advanced scarring.
Investigations
- Visual acuity testing (age-appropriate methods).
- Slit-lamp examination to characterize the opacity.
- Corneal topography in older children, if feasible.
- B-scan ultrasonography when posterior segment visualization is poor.
- Nutritional assessment in cases of suspected vitamin A deficiency.
Treatment
At ECWA Eye Hospital, Kano, most treatment is conservative due to limited surgical options:
- Observation and counseling for stable opacities not involving the visual axis.
- Pharmacological mydriasis to improve vision if the opacity is paracentral.
- Corneal tattooing in selected cases for cosmetic purposes.
- Optical iridectomy may be beneficial when there is a clear cornea at the periphery, allowing light entry.
The mainstay of definitive treatment is corneal transplantation. Unfortunately, this is not feasible in our environment, as there are no cornea banks in Nigeria due to cultural reluctance to donate eyes. Even when a transplant is available outside the country, cost and logistics limit access for most patients.
Follow-Up
- Regular monitoring for amblyopia in children.
- Visual rehabilitation, where possible, with low-vision aids.
- Continuous counseling of parents regarding prognosis and realistic expectations.
Prevention and Control
- Measles immunization to prevent measles keratitis.
- Vitamin A supplementation through national child health programs.
- Discouraging harmful traditional eye medications through community education.
- Public awareness on eye safety to prevent trauma.
- Advocacy for eye donation and the establishment of cornea banks in Nigeria.
Conclusion
Corneal opacity remains a preventable cause of childhood blindness in Nigeria. The main causes—measles, harmful traditional practices, trauma, and vitamin A deficiency—reflect gaps in public health awareness and preventive care. While corneal transplantation offers the best chance of visual rehabilitation, it is not currently feasible in Nigeria due to the lack of donor tissue. Stronger preventive measures, health education, and advocacy for cornea donation are essential to reduce this burden.
Interesting Patient Case
A 9-year-old boy presented with bilateral corneal scars following measles keratitis at age 4. His vision was reduced to counting fingers at 2 meters. Parents had initially used local herbal preparations in both eyes, which worsened the scarring. After counseling, he was offered an optical iridectomy in one eye where the peripheral clear cornea remained. Post-surgery, his vision improved enough for him to read large print, significantly enhancing his ability to participate in school. This case highlights the challenges of late presentation and the importance of preventive public health strategies.
Author and Reviewer’s Reflections
At ECWA Eye Hospital, Kano, we frequently encounter children with corneal opacity due to preventable causes. In the absence of corneal transplant services, our approach has been to offer conservative and palliative options such as mydriasis, tattooing, and optical iridectomy, which, though not curative, can provide functional vision or cosmetic relief.
Our experience has shown that public health education is the most effective long-term strategy. By emphasizing measles vaccination, vitamin A supplementation, and discouraging harmful traditional practices, we believe the incidence of childhood corneal blindness can be significantly reduced in Nigeria.
- Abdull MM, Sivasubramaniam S, Murthy GV, Gilbert C, Abubakar T, Ezelum C, Rabiu MM. Causes of blindness and visual impairment in Nigeria: the Nigeria national blindness and visual impairment survey. Investigative ophthalmology & visual science. 2009 Sep 1;50(9):4114-20.
- Gilbert C, Foster A. Childhood blindness in the context of VISION 2020: the right to sight. Bulletin of the World Health Organization. 2001;79(3):227-32.
- Onakpoya OH, Adeoye AO. Childhood eye diseases in southwestern Nigeria: a tertiary hospital study. Clinics. 2009 Oct 1;64(10):947-52.
- Nkanga ED, Umana UI, Ibanga AA, Ezeh EI, Ani EU, Nkanga DG, Etim BA, Akpan SI. Pediatric Corneal Transplantation in Uyo, Nigeria: Early Experiences. Nigerian journal of clinical practice. 2023;26(11):1772-6.
- Ezinne NE, Nnadi CJ, Mashigo KP, Onoikhua EE. Causes of Childhood Blindness among Children Seen at the National Eye Centre, Kadu-na, Nigeria. J Ophthalmic Clin Res. 2018;5:39.
Author's details
Reviewer's details
Corneal Opacities in Children: A Nigerian Perspective
Corneal opacity is one of the leading causes of childhood blindness in Nigeria and other developing countries. The cornea is a transparent tissue that plays a critical role in focusing light onto the retina. Any scarring or opacity in the cornea leads to impaired vision, which may be severe and irreversible.
In developed countries, corneal opacities in children are often addressed with keratoplasty (corneal transplant), but in Nigeria, this is rarely feasible due to the absence of cornea banks. Cultural beliefs against eye donation have hindered the establishment of sustainable corneal transplant services.
At ECWA Eye Hospital, Kano, the common causes of corneal opacity in children include measles keratitis, harmful traditional eye medications (used for conjunctivitis and other minor eye complaints), trauma, vitamin A deficiency, and ophthalmia neonatorum. These are preventable causes, yet they continue to affect many children who eventually present with profound visual impairment.
- Abdull MM, Sivasubramaniam S, Murthy GV, Gilbert C, Abubakar T, Ezelum C, Rabiu MM. Causes of blindness and visual impairment in Nigeria: the Nigeria national blindness and visual impairment survey. Investigative ophthalmology & visual science. 2009 Sep 1;50(9):4114-20.
- Gilbert C, Foster A. Childhood blindness in the context of VISION 2020: the right to sight. Bulletin of the World Health Organization. 2001;79(3):227-32.
- Onakpoya OH, Adeoye AO. Childhood eye diseases in southwestern Nigeria: a tertiary hospital study. Clinics. 2009 Oct 1;64(10):947-52.
- Nkanga ED, Umana UI, Ibanga AA, Ezeh EI, Ani EU, Nkanga DG, Etim BA, Akpan SI. Pediatric Corneal Transplantation in Uyo, Nigeria: Early Experiences. Nigerian journal of clinical practice. 2023;26(11):1772-6.
- Ezinne NE, Nnadi CJ, Mashigo KP, Onoikhua EE. Causes of Childhood Blindness among Children Seen at the National Eye Centre, Kadu-na, Nigeria. J Ophthalmic Clin Res. 2018;5:39.
Content
Author's details
Reviewer's details
Corneal Opacities in Children: A Nigerian Perspective
Background
Corneal opacity is one of the leading causes of childhood blindness in Nigeria and other developing countries. The cornea is a transparent tissue that plays a critical role in focusing light onto the retina. Any scarring or opacity in the cornea leads to impaired vision, which may be severe and irreversible.
In developed countries, corneal opacities in children are often addressed with keratoplasty (corneal transplant), but in Nigeria, this is rarely feasible due to the absence of cornea banks. Cultural beliefs against eye donation have hindered the establishment of sustainable corneal transplant services.
At ECWA Eye Hospital, Kano, the common causes of corneal opacity in children include measles keratitis, harmful traditional eye medications (used for conjunctivitis and other minor eye complaints), trauma, vitamin A deficiency, and ophthalmia neonatorum. These are preventable causes, yet they continue to affect many children who eventually present with profound visual impairment.
Further readings
- Abdull MM, Sivasubramaniam S, Murthy GV, Gilbert C, Abubakar T, Ezelum C, Rabiu MM. Causes of blindness and visual impairment in Nigeria: the Nigeria national blindness and visual impairment survey. Investigative ophthalmology & visual science. 2009 Sep 1;50(9):4114-20.
- Gilbert C, Foster A. Childhood blindness in the context of VISION 2020: the right to sight. Bulletin of the World Health Organization. 2001;79(3):227-32.
- Onakpoya OH, Adeoye AO. Childhood eye diseases in southwestern Nigeria: a tertiary hospital study. Clinics. 2009 Oct 1;64(10):947-52.
- Nkanga ED, Umana UI, Ibanga AA, Ezeh EI, Ani EU, Nkanga DG, Etim BA, Akpan SI. Pediatric Corneal Transplantation in Uyo, Nigeria: Early Experiences. Nigerian journal of clinical practice. 2023;26(11):1772-6.
- Ezinne NE, Nnadi CJ, Mashigo KP, Onoikhua EE. Causes of Childhood Blindness among Children Seen at the National Eye Centre, Kadu-na, Nigeria. J Ophthalmic Clin Res. 2018;5:39.
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