Ms. I.E is a 29-year-old female with a history of chronic allergies in her childhood. Her brother had been recently diagnosed with keratoconus. She came to us for a second opinion, after being diagnosed with keratoconus in another hospital in Paris. She said that she had received no explanation there but was just told « you have keratoconus », and that the doctor indicated an « urgent need for cross-linking ». She was not questioned about eye rubbing habits and allergies.
Her refraction at the first visit (01/12th/2016) was : Right Eye (RE) 20/32 with -2.25 (-2.75 x 40 °) and Left Eye (LE) 20/20 with +0.25 (-2.5 x 145 °).
Clinical examination with the slit lamp revealed a suspicion of an irregular inferior corneal bulge more pronounced in the right eye. We also found bilateral Fleischer rings (Fleischer rings are pigmented rings in the peripheral cornea, resulting from iron deposition in basal epithelial cells, in the form of hemosiderin).
Corneal topography revealed the presence of bilateral keratoconus more pronounced in the right eye.
At her first visit with us, we interrogated her about her eye rubbing and sleeping habits. The patient admitted to rubbing her eyes very frequently, especially in the mornings. With regards to her sleeping habit, the patient informed us that she sleeps on her right side with her head « pushing » on the arm. She is right-handed.
We explained to the patient that since vigorous rubbing had preceded the drop in visual acuity, this habit may have caused the cornea to deform in her case. She confessed that she had rubbed her eyes very often in her childhood, as she suffered from allergic conjunctivitis. She also informed us that astigmatism was noted in her eyes when she turned 18.
We strongly advised this patient to stop eye rubbing and to change her unhealthy sleeping position to avoid chronic compression on the right eye.
Here are pictures of the patient rubbing her eyes and her profiles
This is a classic example of bilateral keratoconus induced by eye rubbing. Eye rubbing preceded the onset of the corneal deformation by several years. Cessation of eye rubbing resulted in the stabilization of the deformation (no keratoconus progression). The patient can next be fitted with rigid gas permeable contact lenses to restore vision.
It is important to explain to teenagers with allergies and allergic tendencies the importance of refraining from eye rubbing.