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 showing how he used to rub his eyes with knuckles
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.