Mr.W.N is a 20-year-old male policeman with no previous medical history or any known keratoconus in his family. He was offered corneal collagen cross-linking in another institution and consulted us for a second opinion. The patient has known allergy to dust mites, and complained of a progressive decrease in visual acuity more pronounced in the right eye than in the left .
His refraction at the first visit (06/20th/2016) was : Right Eye (RE) 20/50 with +4.5 (-5.75 x 70 °) and Left Eye (LE) 20/25 with +0.25 (-2.75 x 110 °).
Clinical examination with the slit lamp suggested an irregular inferior corneal bulge more pronounced in the right eye. We found also 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), and tarsal papillae (indicating chronic ocular allergy) in both eyes.
Corneal topography revealed the presence of bilateral keratoconus more pronounced in the right eye.
When asked about the possibility of frequent eye rubbing, the patient admitted to rubbing his eyes with his knuckles when working in front of the computer. He is right-handed and sleeps on the stomach, with the head lying on his right arm.
We explained to the patient that vigorous and chronic eye rubbing may have caused the cornea to deform permanently in his case. We strongly advised this patient to stop eye rubbing, and to change his unhealthy sleeping position.
Here are pictures of patient rubbing his eyes and profiles
Eye rubbing has preceded the onset of keratoconus by many years, in a context of chronic atopy and perennial ocular allergy. The specific rubbing pattern (compression of the eyes with the thumb and index finger of the same hand) often results in a markedly asymmetric deformation, more pronounced in the eye rubbed by the thumb. Logically, the cessation of eye rubbing case has interrupted the progression of keratoconus in this case.