The patient
Patient right profile
Bilateral Keratoconus
stable since the first visit
Identity : Mr D.U
First visit : 06/25/2013
Last visit : 03/06/2018
Mr D.U is a 20 year old male engineer with no previous medical history, or any known keratoconus in his family (brother without KC). He complained of a progressive decrease in visual acuity in both eyes, but greater in right eye.
The keratoconus was diagnosed around the age of 10, he told us that he often had tics with vigorous eye rubbing during his childhood.
His refraction was RE 20/30 -2.50 (-3.25 x 140°) and LE 20/20 -1.50 (-1.50 x 150°)
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 right eye.
The patient is left handed and spends a lot of time in front of the computer screen. He admitted to rubbing her eyes during work, especially right eye. About sleep position, he used to sleep on the right side, causing some right eye compression and contact against the pillow. He also used to rub his eyes after shower.
He was then advised to stop eye rubbing
PATIENT RIGHT PROFILE
PATIENT LEFT PROFILE
PATIENT RUBBING HIS RIGHT EYE
PATIENT RUBBING HIS LEFT EYE WITH KNUCKLES
RIGHT EYE GLASS
LEFT EYE GLASSPatient showing how he used to rub his eyes with knuckles
Here are the Orbscan quadmaps, Pentacam maps and Ocular Response Analyzer (ORA) results of the first visit .
ORBSCAN RIGHT EYE (1st Visit) The Orbscan map suggests the presence of keratoconus. The anterior (top right) and posterior (top left) elevation maps suggest an important negative asphericity and toricity (ridge-island pattern). This increased prolateness and toricity translates into a "small bow tie" pattern on the axial curvature map (bottom left); By contrast, the pachymetry (thickness map - bottom right) is relatively preserved, but discloses a slight infero-temporal thinning.
ORBSCAN LEFT EYE (1st Visit) The Orbscan analysis is almost superimposable to that of the right eye. The axial curvature map (bottom left) shows more irregularity (inferior steepening).
RIGHT EYE PENTACAM (1st VISIT)
LEFT EYE PENTACAM (1st VISIT)
RIGHT EYE ORA.
LEFT EYE ORA.Difference maps were performed at each subsequent visit. No evolution was observed between the first and last visits. The keratoconus is stable, more than 5 years after the patient definitively stopped rubbing his eyes
The difference map is computed as the "point by point" difference between 2 different examinations (here taken at different time points: the first - middle column in 2016, and the second -first column in 2017. The resulting subtraction is shown in the third (right) column. Greenish colors indicate the absence of change. There is no significant change between these two examinations. This demonstrates objectively the stability of the corneal deformation.
As for the right eye (see legend for explanations), there is no change between the 2016 and 2017 time points examinations. The corneal deformation is stable (no progression).
RIGHT EYE PENTACAM DIFFERENTIAL MAPS : There is no change between the 2013 and 2018 time points examinations. The corneal deformation is stable (no progression).
LEFT EYE PENTACAM DIFFERENTIAL MAPS : There is no change between the 2013 and 2018 time points examinations. The corneal deformation is stable (no progression).In this case, bilateral eye rubbing with the knuckles preceded the onset of keratoconus by many years. Both right and left eyes have keratoconus of the same severity. There was no history of atopy or allergy, or any irritant triggers for eye rubbing. The patient simply enjoyed rubbing her eyes, as it was pleasurable and induced a sense of relaxation.
A complete cessation of eye rubbing was sufficient to halt progression of keratoconus in this case, like many of the other cases described in this website.
