Ms B.N is a 32 year old female with no previous medical history, or any known keratoconus in her family. She complained of a progressive decrease in visual acuity in both eyes over a period of two year .
Her refraction at the first visit was: Right eye (RE): 20/25 -1.25 (-3.5 x 15 °) and Left eye (LE) 20/60 -5.5 (-6.25 x 155 °)
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, more pronounced of left eye.
The patient is right handed and spends a lot of time in front of the computer screen. She admitted to rubbing her eyes since teenage period but more vigoursly when she started working on her thesis of history, especially left eye. She rubbed her right eye repeatidly, because of a foreign body sensation due to the contact lens. She sleeps constantly on the left side, causing some left eye compression and contact against the pillow.
She was then advised to stop eye rubbing
This case strongly suggests that eye rubbing can trigger keratoconus, even when there are no associated allergies or atopic conjunctivitis. Contact lens wear can indirectly precipitate keratoconus, as contact lenses often trigger itch and pruritic sensations, leading to eye rubbing.