Visual rehabilitation of pediatric corneal blinds is a major challenge to corneal transplant surgeons. Penetrating keratoplasty is the only way to restore vision and prevent irreversible blindness due to amblyopia in children. Indications of penetrating keratoplasty may be grouped into congenital corneal opacities and acquired corneal opacities. Penetrating keratoplasty in children should be performed at the earliest to prevent irreversible amblyopia. Neonates due to immunological immaturity are less predisposed to graft rejection. Detailed examination includes visual acuity test. Response to light stimulus, fixation at light source and following of the movement of illuminated object or light source are helpful. Ultrasonography, A scan and B scan are performed to evaluate vitreous and retina status. The major constraints to perform corneal transplants in neonates include technical difficulties due to small eyes and positive posterior pressure. The abnormalities should be first corrected so that the graft surface following surgery is well protected and the integrity is not affected. Donor’s age between 4 and 30 years is best suited for children. Extremely high positive posterior pressure is a major intraoperative problem encountered. Surgical procedure should be completed in a shortest possible time. Graft size may be determined according to the diameter of the cornea. Some alternative to keratoplasty are also considered. Success of corneal transplant surgery is determined by meticulous perioperative care. Complications should be taken care of as they can be early, intermediate and late. Glaucoma, amblyopia should be taken care of, because they can cause failure of the graft. Keratoprosthesis is used in high risk cases for corneal transplant surgery. It means placing an optical device in the host cornea. Pediatric corneal transplant surgery is a team effort.