The patient
Picture illustration
Unilateral Keratoconus induced by eye rubbing,
stable since the first visit
Identity : Mr. B.K
First visit : 06/08/2015
Last Visit : 1/15/2016
Mr. B.K is a 48-year-old male policeman with no previous history of atopy or keratoconus in the family. He complained of a progressive decrease in visual acuity in the left eye for the past year.
His Refraction was : RE 20/20 +0,5 (-0,75 x 105 °) and LE 20/25 -1,50 (-2,25 x 40 °).
When asked about eye rubbing, he admitted rubbing his eyes regularly at work, especially the left eye with his knuckles.
Clinical examination with the slit lamp revealed an irregular corneal bulge in the left eye with a Fleischer ring. The right eye examination was essentially normal .
We advised him to stop eye rubbing.
Unfortunately we do not have pictures of this patient.
Here are the Orbscans and ORA maps of the first visit .
ORBSCAN RIGHT EYE (1st VISIT). The right eye topography is unremarkable
ORBSCAN LEFT EYE (1st VISIT). This topography maps strongly suggests the presence of a keratoconus pattern. The elevation maps of the anterior (top right) and posterior (top left) corneal surfaces show increased negative asphericity (hyperprolateness) and toricity (astigmatism). The axial curvature map (bottom left) reveals the presence of a marked infero-central steepening. The pachymetry (thickness) map (bottom right) reveals rapid central thinning; These features are typically observed in corneas with keratoconus
ORA RIGHT EYE
ORA LEFT EYEDifference maps were performed at each subsequent visit. No evolution was observed between he first and last visits. The keratoconus is stable. This patient has stopped rubbing his eyes .
ORBSCAN RIGHT EYE (2nd VISIT). The right eye topography is unremarkable
ORBSCAN LEFT EYE (2nd VISIT). Relatively centered mild keratoconus pattern.
ORBSCAN DIFFERENTIAL MAP OF RIGHT EYE : BETWEEN 1st and 2nd VISITS
ORBSCAN DIFFERENTIAL MAP OF LEFT EYE : BETWEEN 1st and 2nd VISITS
ORBSCAN RIGHT EYE (3rd VISIT)
ORBSCAN LEFT EYE (3rd VISIT)
PENTACAM DIFFERENTIAL MAPS OF RIGHT EYE : BETWEEN 2nd and 3rd VISITS. the right eye is normal and remains so over time.
PENTACAM DIFFERENTIAL MAPS OF LEFT EYE : BETWEEN 2nd and 3rd VISITS. The difference map (last column) reveals the stability of the corneal deformation (no keratoconus progression).This case, like many others on this site, reveals that the asymmetric or unilateral character of keratoconus is mainly related to the way the patient rubs his eyes. By preferentially rubbing one eye, the patient selectively induces keratoconus on the same side. The dominant hand is usually stronger, rubs harder, and as it is used more often (« dominant » hand), is more likely to harbour germs and irritants, and thus transfer more allergens to the ocular surface. This alone can explain in part, the asymmetric affliction of keratoconus in many patients.
It is essential to seek a history of eye rubbing in all patients with keratoconus, especially in unilateral or asymmetric cases.
