Keratoconus in a 4-year-old Girl with a Strong Family History of Keratoconus

Purpose: To present the diagnosis and management of the youngest-described keratoconus patient, despite the absence of any systemic or local risk factors except the presence of a strongly positive family history of keratoconus. Methods: A retrospective case report. Results: A 4-year-old female child with free past medical and ocular histories, and a strongly positive family history of keratoconus, presented with deterioration in her vision in the previous 6 months as observed by the family. Objective/subjective refraction showed high astigmatism. Corneal tomography using the Scheimpflug camera Pentacam® HR confirmed the diagnosis of keratoconus in both eyes. Conventional corneal collagen crosslinking (CXL) procedure was performed shortly with a stabilization effect observed over a 1-year follow up period. Conclusion: Keratoconus onset may occur in early childhood, especially in patients with strong family history of the disease even in the absence of systemic or ocular risk factors. So, early screening before the age of 4 years should be done for all children of a family history of keratoconus. Crosslinking may be an effective and safe procedure for very young patients diagnosed with keratoconus.