Here are the Orbscan quadmaps, Pentacam maps and Ocular Response Analyzer (ORA) results of the first visit .

In this case, bilateral eye rubbing with the fists and knuckles preceded the appearance of keratoconus by many years. Both right and left eyes have keratoconus of similar stage. There was no allergy or history of atopy. The patient simply enjoyed eye rubbing, which she found pleasurable by inducing a sense of calm in her. This case strongly suggests that eye rubbing can trigger keratoconus, even when there are no associated allergies and atopic conjunctivitis. Cross linking is never an urgent procedure, as our wide experience shows that the cessation of eye rubbing is sufficient to stabilize corneas with keratoconus of any stage.

Cross-linking is a technique thought of and conceived to stiffen the cornea (through the collagen of the corneal stroma). However, the stiffening of the cornea has not been observed or documented in clinical conditions (in vivo). Some doctors claim that CXL must work, hence the instruments are failing to measure the stiffening post-operatively (while these instruments would not fail to measure any further weakening, curiously). In our opinion, the lack of stiffening outside of in vitro experimentation means that for reasons that should be explored further, CXL fails to restore impaired corneal biomechanics significantly. In fact, the body of observations we collect everyday teaches us that keratoconus is not a primary inherited corneal collagen disease, but the result of excessive local trauma (eye rubbing). Hence, it is more important to stop the root cause mechanism (eye rubbing) than to try to stiffen a cornea that is focally but not globally weakened, as demonstrated by recent studies.

While some observations suggest that CXL could stabilize some corneas with keratoconus, some meta-analyses have tempered this conclusion (see Cochrane library conclusions about keratoconus and CXL).

While some patients are anxious to get a procedure recently approved by the United States FDA and often presented as a « cure for keratoconus » performed on themselves, some others, like this patient, are skeptical and reluctant to undergo a possibly invasive procedure (the irradiation of the corneal stroma with UV light creates free radicals and keratocytes apoptosis, which may not be desirable on tissues already damaged by the excessive rubbing forces). The progression of keratoconus is slow, over a matter of months, not days. There is therefore never any urgency to perform cross-linking. It is better to temporize and reexamine the patient a few weeks later. Most importantly, proper information about eye rubbing must be given to the patient, and the benefits brought about by the cessation of this habit clearly explained.

In our experience, all patients who stopped rubbing their eyes have shown no progression of their disease. These experiences are shared on this site, and should give hope to the many patients with keratoconus.