Acute bilateral diffuse corneal opacity in a child

PURPOSE: To report a case of acute bilateral corneal opacity related to bacterial blepharoconjunctivitis. METHODS: Interventional case report. An 18-month-old boy had bilateral red eyes with discharge and periorbital eczema. Bilateral corneal opacity suddenly developed 1 week later. RESULTS: All clinical assessments and laboratory evaluations of viral infection and autoimmune profiles were negative except for growth of coagulase-negative staphylococcus and propionibacterium acnes from conjunctival discharge. After systemic and topical antibiotic treatment, the opacity and inflammation of both eyes decreased. The left cornea became clear, but the right eye had a sequela of corneal opacity with stromal neovascularization and conjunctival scarring. Penetrating keratoplasty was performed in the right eye 6 months later. Histology at that time showed neovascularization in the deep stroma with perivascular mononuclear cell infiltration and decreased endothelial cells. CONCLUSIONS: Acute bilateral corneal opacity is rare but may occur in children with bacterial blepharokeratoconjunctivitis. Ocular surface inflammation may be induced by bacterial toxin reaction. Combined use of antibiotics and steroids may save the vision in such patients.