The patient
Patient right profile
Bilateral Asymmetric Keratoconus induced by eye rubbing
Identity : Ms Z.N
First visit : 04/25/2017
Last Visit : 01/02/2018
Ms. Z.N, is a 29-year-old female with no previous medical history except for mild atopy. She has no known family history of keratoconus. She presented to us with complaints of blurring of vision in the left eye.
Her refraction at the first visit (03/30th/2017) was: Right Eye (RE) 20/25 with -0.25 (-1 x 85 °) and Left Eye (LE) 20/100 with -9 (-8.5 x 170 °).
Slit lamp examination revealed bilateral keratoconus with Fleischer rings.
Corneal topography confirmed the presence of bilateral keratoconus, more pronounced in the left eye.
The patient was a receptionist in a hotel in Paris (since 2012), and was born in Algeria. She suffers from chronic stress and fatigue and has psoriasis. When asked about eye rubbing at the first visit, she admitted to rubbing her eyes occasionally.
We provided some explanation about the plausible direct effect of eye rubbing on the onset and progression of keratoconus. We strongly advised her to pay attention to possible subconscious rubbing episodes, and to stop rubbing her eyes.
Here are pictures of the patient rubbing her eyes and her profiles
PATIENT RIGHT EYE PROFILE
PATIENT LEFT EYE PROFILE
PATIENT SHOWING HOW SHE RUBS HER EYES. At her second visit, she admitted to rubbing her eyes quite "intensively".
The patient was accompanied by her room-mate at her second visit. Her room-mate confirmed that the patient rubbed her eyes in the past and verbalised that the rubbing was so vigorous that it literally frightened her!Here are the Orbscan quadmaps, OPDscan (topography and aberrometry) maps and Ocular Response Analyzer (ORA) results at the first visit .
RIGHT EYE ORBSCAN (1st VISIT). This is a characteristic keratoconus pattern, with a marked inferior steepening (bottom left), and central thinning (bottom right).
LEFT EYE ORBSCAN (1st VISIT). The corneal deformation (keratoconus) is more pronounced than in the right eye.
RIGHT EYE OPDscan. The vertical asymmetry is responsible for an elevation in the vertical coma.
LEFT EYE OPDscan. Aberrometry allows us to quantify the reduction in optical quality. The wavefront aberrations here are increased, and this explains the poor visual performance, despite the best spectacle correction.
RIGHT EYE ORA. The corneal hysteresis is low, and the height of the peaks is quite reduced.
LEFT EYE ORA. The hystesis value and the height of the applanation peaks are reduced.Difference maps were performed at each subsequent visit. No evolution has been observed between the first and last visits. The keratoconus has not progressed 9 months since the patient stopped rubbing her eyes.
RIGHT EYE ORBSCAN (2nd VISIT)
LEFT EYE ORBSCAN (2nd VISIT)
RIGHT EYE PENTACAM (2nd VISIT)
LEFT EYE PENTACAM (2nd VISIT)
RIGHT EYE ORBSCAN (3rd VISIT)
LEFT EYE ORBSCAN (3rd VISIT)
RIGHT EYE ORBSCAN (4th VISIT)
LEFT EYE ORBSCAN (4th VISIT)
PENTACAM DIFFERENTIAL MAPS : RIGHT EYE. No significant changes are detected.
PENTACAM DIFFERENTIAL MAPS : LEFT EYE; As for the right eye, there is no keratoconus progression in the left eye between the first and second visits.
RIGHT EYE ORBSCAN (5th VISIT)
LEFT EYE ORBSCAN (5th VISIT)
RIGHT EYE PENTACAM (5th VISIT)
LEFT EYE PENTACAM (5th VISIT)
PENTACAM DIFFERENTIAL MAPS : RIGHT EYE. No significant changes are detected.
PENTACAM DIFFERENTIAL MAPS : LEFT EYE. No significant changes are detected.« A child or teenager who never rubs his eyes never gets keratoconus ».
If this etio-pathogenic conception is true, then the eradication of eye rubbing would eradicate the disease. Our clinical practice confirms the fact that the cessation of eye rubbing makes it possible to arrest the progression of keratoconus. This is a fundamental point. The hypothesis is based on numerous clinical observations (like many cases on this website) and deductions made during the diagnosis and follow-up of keratoconus patients. Some patients who rub only one eye develop a true one-sided keratoconus.
When keratoconus patients stop rubbing their eyes definitively, the keratoconus no longer progresses. This renders obsolete the concept and therapeutic aims of cross-linking, whose effectiveness when measured objectively is doubtful, and is unfortunately being performed even in cases with no documented progression.
The cessation of eye rubbing and proper allergy therapy are the best tools in preventing the onset and/or evolution of keratoconus.
