Ms. F.T is a 32-year-old teacher, with no previous medical history or any known history of keratoconus in the family. She initially consulted us for refractive surgery suitability. She complained of a progressive decrease in visual acuity in both eyes over the last 5 years.
Ms E.M is right handed and sleeps on her right side, with the head buried in the pillow .
Her refraction at first visit was : Right eye (RE): 20/20 -1.75 (-4 x 35°) and Left eye (LE) 20/20 – 0.25 (-3.75 x 165°).
Slit lamp examination revealed signs of keratoconus with Fleischer rings and tarsal papillae in both eyes (Fleischer rings are pigmented rings in the peripheral cornea, resulting from iron deposition in basal epithelial cells, in the form of hemosiderin).
She has been wearing rigid gas permeable contact lenses since the age of 26, and it was then that her eye rubbing habit started. She confessed that she would rub her eyes more than 10 times during the day, especially during extended periods of work in front of the computer, and after removal of the contact lenses .
We strongly advised this patient to stop rubbing her eyes.
Here are pictures of the patient rubbing her eyes and her profiles
This case is another example where eye rubbing is not associated with or induced by allergy, but instead is a consequence of late night work and extended work in front of the computer, which causes visual fatigue associated with dry eye. This visual fatigue is relieved by eye rubbing, which eventually becomes a habit.
The importance of the position of sleep is often neglected. An unhealthy sleeping position results in repeated and prolonged trauma to the cornea; this triggers eye rubbing in the mornings upon awakening. In some cases, we prescribe a nocturnal eye protection shell, which shields the eye and eyelids from extended contact with the linen, pillow and bed, and also allows the patient to be more aware of possible rubbing.
We also note in this case a common risk factor for eye rubbing: the use of rigid gas permeable contact lenses. These lenses often cause discomfort when worn which encourages eye rubbing when removed at the end of the day.
The repeated and sustained friction on the eye evoked by eye rubbing are deleterious to corneal stability and responsible for pathological deformation of the cornea (warpage), culminating in the classic picture of keratoconus. The strict cessation of eye rubbing, together with efficient dry eye management, are key in the prevention of progression of keratoconus.