The patient
Patient right profile
Bilateral Keratoconus induced by eye rubbing, stable since the first visit
Identity : Mr A.B
First visit : 11/16/2016
Last Visit : 09/12/2017
Mr A.B is a 31 year old male with no previous medical history, or any known keratoconus in his family. He complained of a progressive decrease in visual acuity in both eyes over a period of one year .
His refraction at the first visit was: Right eye (RE): 20/25 -3.25 (-3 x 90 °) and Left eye (LE) 20/25 -2.25 (-3.25 x 105 °)
Slit lamp examination revealed features of keratoconus in both eyes with thin and steep corneas and Fleischer rings. (Fleischer rings are pigmented rings in the peripheral cornea, resulting from iron deposition in basal epithelial cells, in the form of hemosiderin).
Corneal topography confirmed the presence of bilateral keratoconus.
The patient is right handed and spends a lot of time in front of the computer screen. He admitted to rubbing his eyes since the age of 23 when he started working. He had been prescribed rigid gas permeable contact lenses for 4 years, and informed us that he would rub his eyes quite vigorously after removing the lenses at the end of the day. He sleeps on his stomach and with his head on his right hand .
We strongly advised this patient to stop rubbing his eyes.
Here are pictures of the patient rubbing his eyes and his profiles
RIGHT PROFILE
LEFT PROFILE
PATIENT RUBBING HIS EYES
SLEEPING POSITION (Right side with head on his right hand)Here are the Orbscan and ORA (Ocular Response Analyser) maps of the first visit .
RIGHT EYE ORBSCAN. Marked keratoconus pattern.
ORA RIGHT EYE 
LEFT EYE ORBSCAN. Marked keratoconus pattern
ORA LEFT EYEDifference maps were performed at each subsequent visit. No evolution has been observed between the first and last visits. The keratoconus is stable over more than 10 months .
This patient has completely stopped rubbing his eyes .
RIGHT EYE ORBSCAN (2nd VISIT)
LEFT EYE ORBSCAN (2nd VISIT)
PENTACAM DIFFERENTIAL MAPS : RIGHT EYE. Stabilization of the keratoconus (the blue pattern could even suggest a reduction in the deformation!)
PENTACAM DIFFERENTIAL MAPS : LEFT EYE. Stabilization of the corneal deformation.
RIGHT EYE ORBSCAN (3rd VISIT)
LEFT EYE ORBSCAN (3rd VISIT)
RIGHT EYE PENTACAM (3rd VISIT)
RIGHT EYE PENTACAM (3rd VISIT)
PENTACAM DIFFERENTIAL MAPS : RIGHT EYE. 
PENTACAM DIFFERENTIAL MAPS : LEFT EYE. This case shows that eye rubbing can be incited in the absence of ocular allergy. It is often triggered by late night work or extended periods in front of the computer screen, which induces a sensation of visual fatigue associated with dry eye, and relieved by eye rubbing as described by the many patients in this website. Various environmental factors and life events can trigger eye rubbing, such as the beginning of a new job (nightshift, extended computer screen work), adaptation to rigid contact lenses (rubbing upon removal), pregnancy (causing more dry eyes) etc. There is a delay between the onset of eye rubbing and the clinical manifestation of keratoconus, which on average is about three years in our cohort of patients.
Eye rubbing is the root cause of the corneal deformation in keratoconus. The cessation of eye rubbing logically halts the progression of the disease.
