The patient
Patient right profile
Bilateral Keratoconus induced by eye rubbing, stable since the first visit
Identity : Mr Z.W
First visit : 01/17/2017
Last Visit : 10/13/2017
Mr. Z.W is a 32-year-old male with no previous medical history, or any known history of keratoconus in the family. He complained of a progressive decrease in visual acuity in both eyes for the past few months. He sleeps on his stomach.
His Refraction at the first visit was : Right eye (RE): 20/20 -5 (-1.5 x 10 °) and Left eye (LE) 20/20 -4 (-3.25 x 160 °).
Slit lamp examination revealed signs of keratoconus with Fleischer rings 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) .
Corneal topography revealed bilateral moderate keratoconus, more pronounced in the left eye.
His wife who was present at the consultation informed us that she had witnessed Mr W.V rubbing his eyes frequently in front of the computer, after the shower and in the evenings at bedtime. He spends long hours in front of the computer screen, and works late into the night.
We strongly advised this patient to stop rubbing his eyes, and explained to him that this habit was the root cause of the corneal deformation in his case.
Here are pictures of the patient rubbing his eyes and his profiles
RIGHT PROFILE
LEFT PROFILE
PATIENT RUBBING HIS EYES
Patient showing his sleep position : pillow in his left hand with direct contact with his left eyePatient rubbing his eyes (inferior part) with knuckles
Here are the Orbscan maps with SCORE Analyser assessment, Pentcam maps, OPDScan and ORA (Ocular Response Analyser) results of the first visit.
ORBSCAN RIGHT EYE. Mild deformation of the corneal surface evocative of early keratoconus.
SCORE ANALYSER RIGHT EYE
PENTACAM RIGHT EYE
OPD RIGHT EYE
ORA RIGHT EYE. There is irregularity of the applanation peaks.
ORBSCAN LEFT EYE. Mild keraotoconus topographic pattern, more pronounced than in the right eye.
SCORE ANALYSER LEFT EYE
PENTACAM LEFT EYE
OPD LEFT EYE
ORA LEFT EYE. Hysteresis is normal, but the height of the peaks is reduced.Difference maps were performed at each subsequent visit. No evolution has been observed between the first and last visits. The keratoconus is stable over the first 9 months of follow-up .
This patient stopped rubbing eyes since the first consultation where he had received proper information on the causal link between eye rubbing and keratoconus genesis.
PENTACAM RIGHT EYE (2nd VISIT)
PENTACAM DIFFERENTIAL MAPS : RIGHT EYE
PENTACAM LEFT EYE (2nd VISIT)
PENTACAM DIFFERENTIAL MAPS : LEFT EYE
ORBSCAN RIGHT EYE (3RD VISIT)
PENTACAM RIGHT EYE (3RD VISIT)
ORBSCAN LEFT EYE (3RD VISIT)
PENTACAM LEFT EYE (3RD VISIT)
PENTACAM DIFFERENTIAL MAPS : RIGHT EYE
PENTACAM DIFFERENTIAL MAPS : LEFT EYEThis case is another example where eye rubbing is not associated with or induced by allergy, but is instead a consequence of visual fatigue from late night work and extended hours of computer work. The visual fatigue is often associated with dry eye, and relieved by eye rubbing, as described by the many patients in this website. It is sometimes necessary to obtain the testimony of the relatives during the consultation, because some patients may not be fully aware of their eye rubbing habits. This is why it is important to arrange a review one month after the first examination. At that point, the patient would have most likely become aware of his practices and the importance to stop eye rubbing.
The repeated and sustained friction inflicted by eye rubbing is directly responsible for pathological remodeling of the cornea which evolves into a permanent deformation. Therefore, suppression of eye rubbing and concomitant dry eye treatment are often sufficient to prevent the development and progression of keratoconus.
