Patient right profile
Mr. T.D, is a 23-year-old male with no previous medical history. There is no known family history of keratoconus . He complained of a progressive decrease in visual acuity in both eyes over one year.
His refraction at the first visit (05/27th/2016) was : Right Eye (RE) 20/100 with -4.50 (-8.75 x 15°) and Left Eye (LE) 20/400 with -8 (-8,75 x 175 °).
Clinical examination with the slit lamp revealed keratoconus in both eyes with bilateral 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 revealed the presence of bilateral keratoconus.
When asked about the possibility of frequent eye rubbing, the patient admitted to enjoying rubbing his eyes with the knuckles & nails. And when asked about his sleeping position, he described sleeping with his head on his arm. He noticed that he often awoke with red eyes in the morning.
We advised him to change his sleeping position, and to stop rubbing his eyes.
Here are pictures of the patient rubbing his eyes and his profiles
In this case, bilateral eye rubbing with the knuckles & nails preceded the appearance of keratoconus. The unhealthy sleeping position (arms covering the eyes) is probably responsible for the need to rub the eyes upon awakening because of the irritation from overnight compression. Both eyes have keratoconus of a similar stage. There was no known allergy or atopic background.
This case demonstrated 1 year stability since the cessation of eye rubbing.
No cross linking was necessary. The cessation of eye rubbing and eradication of any unnecessary ocular compression is the most important factor for stabilization of keratoconus of any stage.
This patient rubbed his eyes partly because he found it pleasurable. It required a lot of explanation and coaxing to persuade him to cooperate and stop his rubbing habit. In other cases where ocular allergy and pruritus coexist, it is not always easy for the patient to restrain from eye rubbing. Actions to reduce all possible risks factors for eye rubbing must be taken.
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- Date 15 août 2017
- Tags Bilateral keratoconus, Enjoyed eye rubbing, Eye rubbing, Fleischer ring, Knuckles rubbing, Male, Nails rubbing, Sleep position