Keratoconus in Children and Adolescents

Purpose. Keratoconus (KC) in children and adolescents presents a particular clinical challenge, as it is characterized by earlier onset, a significantly higher rate of progression, and more severe findings at initial diagnosis compared to the adult form. While keratoconus was long considered an isolated, non-inflammatory corneal degeneration, a fundamental paradigm shift has taken place over the past decade. This review article summarizes the current state of knowledge regarding pediatric keratoconus and discusses the clinical implications of a systemic reevaluation of the disease.

Material and Methods. The literature review was conducted using a systematic search of the PubMed database published between 2015 and 2026. The search strategy involved the use of six MeSH keywords: keratoconus; paediatrics; prevalence; aetiology; diagnostic; therapy. The selection criteria included peer-reviewed articles, reviews and studies employing specific methodologies and focusing on particular populations. The 320 publications identified through the literature search were evaluated for thematic relevance through title, abstract, and full-text screening. A total of 41 articles were included in this narrative review. A full systematic literature search in accordance with PRISMA criteria was not carried out.

Results. Current evidence indicates that KC is a multifactorial disease in which genetic predisposition, systemic inflammation, metabolic dysregulation, and biomechanical instability interact closely. These mechanisms are particularly evident in childhood. Modern diagnostic procedures such as AI-assisted corneal tomography, biomechanical analyses, and epithelial thickness mapping now enable early detection of subclinical stages. Therapeutically, early corneal cross-linking (CXL) has established itself as the primary procedure for inhibiting progression, supplemented by systemic interventions such as the management of atopy, vitamin D deficiency, and micro­nutrient deficiencies.

Conclusion. Keratoconus in childhood and adolescence is increasingly understood as a local manifestation of systemic processes. The past decade has transformed keratoconus from a surgically dominated condition into a prevention-­oriented discipline. The combination of AI-assisted diagnostics, accelerated CXL procedures, and systemic stabilization represents the current gold standard. The future of therapy lies in personalized medicine that addresses the underlying metabolic dysfunction before biomechanical damage becomes irreversible. For optometry, this means an expanded diagnostic and preventive role that goes beyond mere refraction.