A term male neonate born by forceps vaginal delivery presented on day 10 of life with watering and opacification of cornea of left eye. There was associated lacrimation, photophobia and blepharospasm. Eye examination under anaesthesia revealed corneal edema (Fig.1) with normal intraocular pressure. Corneal edema resolved following topical corticosteroids but on repeat examination vertically oriented breaks were noted in descemet membrane (Fig.2b, white double arrow). These breaks were associated with myopic astigmatism of 3.50 D along the axis of break. Refractive correction was prescribed along with standard occlusion therapy. At follow up of 2 months and later at 2 years, refractive error was stable with the best corrected visual acuity of 20/30 in the affected eye.

Fig.1 Slit lamp photographs of affected (left) eye; Panel A: on 10th day of life revealing diffuse corneal edema (white arrow); Panel B: On day 28 of life revealing vertical break at the level of descemet’s membrane (white, double arrow).

Forceps injury to eye usually occurs as a result of compression of the globe between the orbital roof and the blade of the obstetric forceps. It is associated with descemet membrane breaks and can cause refractive errors. These breaks being small and obscured by corneal edema are easily missed. A normal intraocular pressure facilitates differentiation from congenital glaucoma. The corneal edema improves within a few weeks, at which time residual single or multiple descemet membrane breaks appear as vertical or oblique median striae. These corneal lesions are primarily unilateral and may cause amblyopia. Loss of vision may be because of the opacities of the striae themselves or because of induced astigmatism, which results in amblyopia. Although penetrating keratoplasty has been the treatment of choice, but this leads to frequent complications in children.