Eye rubbing as the root cause of keratoconus?
Keratoconus has been labelled a “dystrophy of unknown origin”, and I have long been fascinated by this mysterious disease. A large proportion of my clinical practice is dedicated to the diagnosis, management and prevention of keratoconus, and for many years I have been intrigued by how structural changes and deformation of the corneal wall are so pronounced in keratoconus, yet paradoxically, few detectable genetic and molecular abnormalities exist in this condition.
Eye rubbing has long been acknowledged as a risk factor for keratoconus, but I believe its role in the pathogenesis of keratoconus has not been accorded sufficient prominence. I have thus undertaken the task to pen an article to suggest to readers a pathophysiological concept of keratoconus that I am increasingly convinced of: that eye rubbing is the root cause or sine qua non for keratoconus (article download). As such, eye rubbing is not a « risk factor », as often coined in medical litterature, but the direct cause of a syndrome marked by a corneal deformation labeled « keratoconus ».
In this article, I have put forth the theory that keratoconus is not a dystrophy of unknown genetics and biomolecular substratum, but rather a syndrome caused by eye rubbing. i.e what has been called “keratoconus” is in essence the direct consequence of mechanical trauma to the cornea by chronic and incessant eye rubbing, resulting in the progressive deformation and thinning of the corneal wall which are hallmarks of the disease. Eye rubbing is the main character of the « mechanical » hypothesis as the etiology of keratoconus:
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