We have noticed that patients with keratoconus often sleep on their stomach or on their side, with direct contact of the eye on the pillow (« pillow hugging »).
Due to the constrained lateral head position with such a sleeping posture, extended pressure against one or both orbits is typically exerted during sleep. Some patients favour sleeping on the right or the left side. The strong correlation between the side which is more compressed on the pillow/arm/hand at night and the side of the more advanced keratoconus suggests that the sleeping habit may play a significant role in the genesis of keratoconus. In this context, asymmetrical eye rubbing may co-exist, with the eye that is compressed being rubbed more. The direct and prolonged contact of the eyelids against the bed linen may increase the contamination of the ocular surface with irritants and allergens such as dust mites, contributing to increased local pruritis and subsequently increased eye rubbing of the affected side.
- Avoid sleeping face down with the eyes pressed against the pillow.
- If sleeping on one side is preferred, avoiding pillow contact and pressure on the eye /eyelids.
- Firmer pillows may help in the proper positioning of the head during sleep.
Protective eyewear (eg eye shields used after cataract surgery) can also be worn during sleep.