Patient left profile
Mr. I.O is a 41-year-old male with eczema, and no known family history of keratoconus. He complained of a progressive decrease in visual acuity greater in the left eye than the right. Keratoconus was diagnosed at another institution in 2014.
His refraction at the first visit at the Rothschild foundation (on 04/11th/2014) was : Right Eye (RE) 20/20 with -1 (-0.75 x 75 °) and Left Eye (LE) 20/20 with -0.75 (-2.5 x 135 °).
Clinical examination with the slit lamp suggested a thin and irregular left cornea.
Corneal topography performed showed the presence of a unilateral keratoconus in the left eye
At the first visit, when asked about the possibility of frequent eye rubbing, the patient admitted to rubbing his eyes when he awoke in the mornings or when working in front of the computer because he enjoyed it.
At the subsequent visits, he verbalized remembering rubbing his eyes frequently during childhood, especially the left eye because of itch from eczema and allergic conjunctivitis (see left profile picture).
The patient is right handed but rubs his left eye with his left hand. He sleeps on his left side, with the head buried in the pillow (pillow hugging)
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.
Here are pictures of the patient rubbing his eyes and his profiles
Here is a video of the patient rubbing his eyes
In this case we find many triggers for eye rubbing like allergy, unhealthy sleeping position and eczema more marked on the left side. The unilateral or asymmetric nature of keratoconus development may be related to the sleeping position (left sided) and the habit of preferentially rubbing the left eye because of his eczema.
The contralateral eye shows a forme fruste keratoconus. The patient admitted to rubbing both eyes, but the left eye more aggressively (because of the itch caused by eczema). His right cornea has an early form of keratoconus because the rubbing is less frequent and vigorous in this eye. This reinforces the hypothesis that eye rubbing, which preceded the onset of keratoconus in this case, is the root cause of it.
From our clinical experience, we notice the existence of families of » eye rubbers » with keratoconus. Given the environmental and genetic heritage of atopy and thin corneas, there can be many within the same family (parents-children, brothers or sisters) who tend to rub their eyes. Depending on the habits of each individual, and the intensity and duration of eye rubbing, the appearance and evolution of keratoconus can be variable.
This case is very informative and is demonstrative of the causal effects of eye rubbing in the pathogenesis of keratoconus.
As demonstrated again in this clinical example, the cessation of eye rubbing and patient education are the best tools in the prevention of the genesis and/or evolution of the disease.
Autres cas :
- Date 3 décembre 2017
- Tags Allergy, Asymmetric, Childhood rubbing, Eczema, Eye rubbing, Knuckles rubbing, Male, Morning rubbing, Sleep position, Unilateral keratoconus, Work rubbing