Pediatric anterior segment disease is a broad subject, but, in this chapter, we will focus largely on the latest developments affecting congenital disease, techniques of pediatric keratoplasty as they pertain to specific corneal diseases, and select, common acquired diseases for which newer therapies have become available. A classification [1] to help differentiate corneal opacities in children is useful in categorizing and managing disease and is used in this chapter to order the below diseases.