The most common causes of acquired corneal scarring before age 6 are herpes simplex keratitis, penetrating injuries, and congenital dystrophies. We performed 18 keratoplasties in 16 eyes of 15 patients under the age of 12 years, achieving clear grafts in 14 eyes (87%). We also performed 11 grafts in nine eyes of eight patients with congenital, central corneal opacities, achieving only one clear graft and four instances of phthisis bulbi or enucleation for buphthalmos. We do not recommend penetrating keratoplasty in patients with unilateral, congenital corneal opacities. However, those with bilateral cloudy corneas should have an attempt at kertoplasty as early in life as possible. The social and psychologic condition of the family often makes the difference between success and failure.