Here are the Orbscan , OPDScan and ORA maps of the first visit .

This case reveals that post-LASIK dry eye causing discomfort and visual fatigue can induce a patient to rub their eyes vigorously in an attempt to relieve their symptoms. Such repeated and sustained mechanical trauma on a thinned cornea (post-LASIK) can be particularly detrimental to the biomechanical integrity of the corneal wall.  Corneal deformation ensues, culminating in what we term « Post-LASIK ectasia« .

Eye rubbing is often neglected in the management of post LASIK ectasia. Although other important risk factors for ectasia exist (eg abnormal pre-operative topography, low residual stromal bed thickness, young patient age etc), the role of eye rubbing in inducing mechanical weakening of the cornea must not be overlooked. Our experience shows that eye rubbing is at the core of the mechanism of post LASIK ectasia, as it usually precedes the surgery (hence the particular abnormal topography pattern pre-operatively), and continues after (in an attempt to alleviate the discomfort induced by dry eye). It is therefore mandatory to sensitize every LASIK candidate to the dangers of pursuing or initiating vigorous and repeated eye rubbing after the surgery.

The cessation of eye rubbing promotes stabilization of the corneal deformation, and in our experience, corneal collagen cross-linking (and its potential complications) can be avoided in patients who co-operate with and adhere to our recommendations to definitively stop rubbing their eyes.