Ms M.W is a 45 year-old female with no previous medical history or any known keratoconus in her family. She has atopic background (asthma, eczema).
Her refraction at the first visit (10/13th/2008) was: Right Eye (RE) 20/25 with -0.25 (-5.5 x 30 °) and Left Eye (LE) 20/25 with -0.25 (-3.25 x 155 °).
Clinical examination with the slit lamp suggested a paracentral inferior thinning more pronounced in the right eye .
Corneal topography revealed the presence of bilateral keratoconus more pronounced in the right eye.
The patient disclosed that she had rubbed her eyes regularly in the past (during childhood), with her knuckles. She confessed that she used to rub her eyes at work front of computer screen.
She also used to sleep on her stomach, on both sides.
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. We strongly advised this patient to stop rubbing her eyes.
Here are pictures of the patient rubbing her eyes and her profiles
Difference maps were performed at each subsequent visit. No evolution was observed between the first and last visits (as seen from the careful inspection of the consecutive Orbscan maps, and the more recent subtraction maps obtained with the Pentacam). The keratoconus is stable, more than 9 years after the patient had definitively stopped rubbing her eyes.
This case demonstrates that the cessation of eye rubbing is the key factor in the stabilisation of keratoconus. In our opinion, this disease is primarily caused by vigorous eye rubbing. The fact that keratoconus progression is invariably arrested when patients stop rubbing their eyes is a strong argument in favor of eye rubbing being the root cause of keratoconus.