THE GENESIS OF KERATOCONUS
How does it all start ?
Mstr. H.R is a 10-year-old male child with no previous medical history or any known family history of keratoconus. He complained of itchy eyes for 2 years.
His refraction at the first visit at the Rothschild foundation (on 11/01st/2017) was : Right Eye (RE) 20/20 with +0.75 (-1.25 x 5 °) and Left Eye (LE) 20/20 with +0.5 (-0.50 x 155 °).
Clinical examination with the slit lamp revealed bilateral tarsal papillae and inferior superfical punctate keratitis. There were no clinical signs of keratoconus.
Corneal topography was performed and revealed the presence of a topographic pattern evocative of early subclinical keratoconus in the left eye.
Here are pictures of the patient’s eye profiles and slit lamp pictures of his ocular surface.
We questioned his mother about the possibility of her son rubbing his eyes frequently. She declared that she had not noticed anything special, but she could remember that she had witnessed her son wiping his left eye more often than the right. We asked this young boy if he knew that he was rubbing his eyes. His answer was clear: not only did he acknowledge rubbing his left eye many times a day, he even confessed that he was finding this habit very pleasurable. He was an avid reader, and when his eyes were itchy, he would rub his left eye, while holding the book in his right hand (he is right handed).
He also likes sleeping on the left side, which is his favorite sleeping position.
His left eye rubbing technique was quite impressive, and amazingly noisy.
Patient performing a noisy eye rub (left eye) with the nail of his left index finger
Patient performing a noisy eye rub (left eye) with his left palm