Mr Q.T, is a 40-year-old male with no known keratoconus in his family. He has a history of atopy (eczema). He first consulted us for a refractive surgery suitability assessment. He had never been suspected of or diagnosed with keratoconus before. The patient complained of a progressive decrease in visual acuity greater in the left eye than the right.
His refraction at the first visit (07/07th/2017) was: Right Eye (RE) 20/20 with -1 (-2 x 90 °) and Left Eye (LE) 20/20 with -3 (-0.25 x 135 °).
Clinical examination with the slit lamp revealed a thin cornea with Vogt’s striae (fine whitish lines in the posterior stroma) and Fleischer ring (Fleischer rings are pigmented rings in the peripheral cornea, resulting from iron deposition in basal epithelial cells, in the form of hemosiderin), in both eyes.
Systematic corneal topography performed routinely for all refractive surgery candidates revealed bilateral keratoconus, more pronounced in the left eye.
When asked about his sleeping habit, the patient revealed that he sleeps on his stomach, with head in the pillow (« pillow hugging« ). He is right handed, and often awoke with red eyes in the morning.
At the first visit, when asked about possible rubbing habits, the patient denied any eye rubbing. We then asked him to pay attention to possible rubbing episodes, and gave him an appointment for a review visit one month later. We prescribed him physiological serum and artificial tears as lubricants to soothe the ocular surface.
At the second visit, the patient confessed that he had become aware that he rubbed his right eye several times a day, especially in the mornings with the knuckles of his right hand. He also alluded to rubbing his eyes at work in front of the computer screen and late at night to relieve ocular fatigue. He described a gesture that he would perform many times a day: he would rub his left eye with the knuckle of his right index finger which were passed under his glasses (refer to the video below). This resulted in a shift of the eyeglass frame to the same side (right side) as the hand rubbing the eye, which is an indirect sign of eye rubbing in eyeglass wearers (« offset glasses sign« ). Mr P.S claimed that he had stopped rubbing his eyes since being made aware of the bad habit.
In this case, the asymmetry between the right eye and left eye deformation is striking. It is strongly correlated to his rubbing and work habits.
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 this patient to stop eye rubbing, and to change his unhealthy sleeping position.
Here are pictures of the patient rubbing his eyes and his profiles