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
« 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.