Patient sleeping position
Mr. M.B is a 29-year-old male with no previous medical history or any known keratoconus in the family. He complained of a progressive decrease in visual acuity more pronounced in the right eye than the left.
His refraction at the first visit at the Rothschild Foundation (on 03/31th/2015) was : Right Eye (RE) 20/20 with -0.25 (-0.50 x 80 °) and Left Eye (LE) 20/20 with +0.25 (-0.75 x 135 °).
Clinical examination with the slit lamp revealed thin and irregular corneas 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. Vogt’s striae are thin vertical streaks located in the posterior corneal stroma (at the level of the Descemet membrane. These folds disappear with external gentle pressure on the globe).
Corneal topography performed at our institution confirmed the presence of bilateral keratoconus.
We investigated the risks factors for eye rubbing a the first visit. This patient disclosed known allergy to dust mites. The patient is left handed, and sleeps on his right side, with the head buried in the pillow or head pressed against his arm
When asked about the possibility of frequent eye rubbing, the patient admitted to rubbing his eyes when he awakes (because of blurry vision), and in the evenings after work. He verbalized that eye rubbing gave him a feeling of well-being.
On subsequent visits, he also confessed to rubbing his eyes heavily when he was child during the allergic episodes which he experienced then. He often had itchy eyes upon awakening, and was prone to rub his eyes vigorously in the mornings. He first noticed problems with his vision in the form of small « light tails » around bright lights at night when he was 17. His first occupation, when he turned 18, involved working night shifts and he described how his vision gradually deteriorated from then onwards.
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, leading to the classic clinical presentation of keratoconus in his case. The patient agreed with this theory as it could explain well the onset and progression of keratoconus in his case. He was concerned about his previous consultation at another hospital, where he was informed that he had a genetic ophthalmic disease, and was not given any information about the causal link between his eye rubbing habits and the generation of keratoconus. .
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
This case is typical of focal corneal deformation induced by chronic eye rubbing that started in childhood. Very often, like many other cases on this site, the eye rubbing begins in childhood and is very often related to allergy. During childhood, the cornea is more deformable and the friction applied is often more intense. Patients will usually notice a decline in vision 3 years after the onset of intense rubbing.
Following treatment of the allergy and cessation of eye rubbing, the keratoconus in this case ceased to evolve.
Chronic eye rubbing reduces the biomechanical resistance of the collagen fibers of the corneal dome and lead to corneal deformation. This biomechanical mechanism is more likely to account for the disparity between right and left eye involvement (patients often rub one eye more than the other), and the focal nature of keratoconus, which has recently been evidenced.
In our experience, the cessation of eye rubbing is the most important parameter in the control of the progression of corneal deformation. Also, allergy must be detected and treated aggressively.
The key in the fight against keratoconus is prevention by educating patients, parents and children about the dangers of eye rubbing.
Autres cas :
- Date 22 octobre 2017
- Tags Allergy, Asymmetric, Bilateral keratoconus, Childhood rubbing, Dry eyes, Inferior keratoconus, Male, Morning rubbing, Night shift, Sleep position