Patient right profile
Mr. E.N is a 32-year-old male who complained of a progressive decrease in visual acuity greater in the right eye than the left. He has two brothers, one with keratoconus and one without. According to the patient, the brother with keratoconus is a frequent eye rubber, while the brother without keratoconus does not rub his eyes.
The patient’s refraction at the first visit at the Rothschild Foundation (on 10/13th/2015) was : Right Eye (RE) 20/32 with -0.5 (-4 x 70 °) and Left Eye (LE) 20/20 with -1 (-0.5 x 175 °).
Clinical examination with the slit lamp suggested a thin and irregular right cornea with a Fleischer ring. Fleischer rings are pigmented rings in the peripheral cornea, resulting from iron deposition in basal epithelial cells, in the form of hemosiderin.
Corneal topography performed showed the presence of a unilateral keratoconus in the right 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 morning. He also admitted to frequent eye rubbing during childhood.
He is right handed and rubs his eyes with his right hand. His technique of eye rubbing is demonstrated in the video below, with the thumb rubbing the right eye and the index finger rubbing the left eye.
The patient sleeps on his right 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 him to stop rubbing his eyes and to change his unhealthy sleeping position.
Here are pictures of the patient rubbing his eyes and his profiles
In this case we find many triggers for eye rubbing like allergy during childhood and unhealthy sleeping position. The unilateral or asymmetric nature of keratoconus development is related to the sleeping position (right sided) and the habit of preferentially rubbing the right eye, especially with the thumb (the force applied is higher).
Many cases presented on this site show that the genesis of keratoconus often begins during childhood, at the time when allergy commences, and this is the dominant factor responsible for inciting eye rubbing .
It is critical to identify children who rub their eyes, because by doing so the occurrence of keratoconus can be prevented. Once keratoconus develops, the deformation is permanent, and the cessation of eye rubbing can only prevent the evolution.
This case is very informative and demonstrative of the causal effects of eye rubbing on the pathogenesis of keratoconus. Cross-linking was unnecessary in this case, as stabilisation of the corneal deformation was achieved with the simple act of cessation of eye rubbing.
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 keratoconus.
Autres cas :
- Date 3 décembre 2017
- Tags Asymmetric, Childhood rubbing, Enjoyed eye rubbing, Inferior keratoconus, Male, Morning rubbing, Sleep position, Unilateral keratoconus