Patient right profile
Mr. P.A is a 29-year-old male with no previous medical history or family history of keratoconus. He complained of a progressive decrease in visual acuity greater in the right eye than the left for 7 years. He has known allergy to dust mites, and rubbed his eyes frequently during childhood (especially the right eye).
His refraction at the first visit at the Rothschild Foundation (on 11/22th/2016) was : Right Eye (RE) 20/60 with -3.00 (-3.25 x 50 °) and Left Eye (LE) 20/35 with -2.5 (-0.75 x 135 °).
Clinical examination with the slit lamp suggested an irregular inferior corneal bulge in the right eye 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 pressure on the globe).
Corneal topography performed at our institution showed the presence of bilateral keratoconus, more pronounced in the right eye.
At the first visit, when asked about the possibility of eye rubbing, he admitted to rubbing his eyes incessantly while at work. Since undertaking the job as a computer engineer, he found that he had to rub his eyes more frequently to relieve digital eye strain. He also gave a history of frequent eye rubbing during childhood due to allergies causing itchy eyes.
He is right handed and sleeps on his right side, with the head buried in the pillow.
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.
We strongly advised this patient to stop rubbing his eyes and to change his unhealthy sleeping position. We also prescribed him eye shields for use while sleeping.
Here are pictures of patient rubbing his eyes and profiles
This case reveals that eye rubbing is often triggered by allergies during childhood and long hours spent in front of the computer screen, which causes visual fatigue associated with dry eye (reduced blinking). These sensations are often relieved (transiently) by eye rubbing, which as described by patients, can be pleasurable and relaxing in such circumstances. These repeated and sustained frictions over the long-term are responsible for a permanent warpage of the cornea, culminating in the condition called « keratoconus ». Rubbing with the knuckles is particularly detrimental to the corneas, because the knuckles are the hardest part of the hands.
Since the cessation of rubbing, there has been no aggravation of the keratoconus in this patient.
Autres cas :
- Date 5 novembre 2017
- Tags Allergy, Asymmetric, Central keratoconus, Childhood rubbing, Computer screen, Eye rubbing, Eye shield, Fleischer ring, Male, Morning rubbing, Offset glasses, Pillow hugging, Sleep position, Work rubbing