Aim 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.

Discussion 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.