Mr. G.Q is a 41-year-old male with no previous medical history or any known keratoconus in his family. He has known allergy to dust mites, and complained of a progressive decrease in visual acuity in both eyes.
His refraction at the first visit (06/28th/2016) was : Right Eye (RE) 20/25 with -3 (-2.75 x 35 °) and Left Eye (LE) 20/25 with -3.25 (-3.50 x 130°).
Clinical examination with the slit lamp suggested an irregular inferior corneal bulge, with bilateral Vogt’s striae and Fleischer rings (Fleischer rings are pigmented rings in the peripheral cornea, resulting from iron deposition in basal epithelial cells, in the form of hemosiderin). Tarsal papillae (indicating chronic ocular allergy) were observed on the inner surface of the eyelids.
Corneal topography revealed the presence of bilateral keratoconus more pronounced in the left eye.
When asked about the possibility of frequent eye rubbing, the patient admitted to rubbing his eyes frequently with his knuckles. He sleeps on his left side.
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 his case. We strongly advised him to stop rubbing his eyes. We also recommended that he change his sleeping position, as extended compression of the eye at night time may cause local irritation and increase contamination by dust mites and irritants, which trigger more pruritus and subsequent eye rubbing.
Here are pictures of the patient rubbing his eyes and his profiles
This is a case of advanced keratoconus caused by chronic vigorous eye rubbing. The eye rubbing preceded the appearance of keratoconus by several years. As in many other cases, there is a correlation between the sleeping position (side) and the laterality of the more advanced keratoconus. Fortunately for this patient, the eye rubbing habit was identified and the disease progression arrested once the patient stopped rubbing his eyes.
The origin of keratoconus remains relatively unknown. However, many observations including this case report and the other cases in this website accredit eye rubbing to be the number one causal suspect. The deformation induced by rubbing is possibly aggravated by a co-existent chronic nocturnal compression (pressure of the pillow on the eye), which itself is a source of chronic irritation and contamination, resulting in pruritus and subsequent rubbing in response to the ocular discomfort.