Patient right profile
Mr. I.N is a 22-year-old male student with no previous medical history or any known family history of keratoconus. He complained of a progressive decrease in visual acuity greater in the right eye than the left. Although he has no allergies of note, he complained of frequent ocular itch and irritation.
His refraction at the first visit at the Rothschild Foundation (on 11/15th/2016) was : Right Eye (RE) 20/40 with -2.25 (-3.5 x 30 °) and Left Eye (LE) 20/32 with -1.5 (-2.25 x 155 °).
Clinical examination with the slit lamp suggested thin and irregular corneas with Fleischer rings. 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 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 frequent eye rubbing, the patient admitted to enjoying rubbing his eyes when he awoke in the mornings or when working in front of the computer. The many hours spent in front of the computer was associated with frequent dry and tired eyes, and eye rubbing induced a sense of relaxation for this patient.
At the subsequent visits, he conveyed that he started rubbing his eyes at the age of 10.
He is right handed and rubs his right eye more forcefully, with the palm of his hand. He 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 this patient to stop rubbing his eyes and to change his unhealthy sleeping position. We also referred him to a specialist for management of his allergies.
Here are pictures of the patient rubbing his eyes and his profiles
In this case we find many triggers for eye rubbing like extended hours of work on the computer, unhealthy sleeping position and allergy during childhood. The asymmetric nature of keratoconus development may be related to the sleeping position (right sided) and the more forceful and preferential rubbing of the right eye with the dominant hand (right handed).
This is a classic example of bilateral keratoconus induced by eye rubbing. Eye rubbing preceded the onset of the corneal deformation by several years. Cessation of eye rubbing resulted in the stabilization of the deformation (no keratoconus progression). The patient can next be fitted with rigid gas permeable contact lenses to restore vision.
This case also illustrates the importance of patient education. Teenagers with allergies and allergic tendencies should be counselled with regards the deleterious effects of eye rubbing before they inflict permanent damage on their corneas.
Autres cas :
- Date 9 décembre 2017
- Tags Allergy, Asymmetric, Bilateral keratoconus, Childhood rubbing, Computer screen, Dry eyes, Enjoyed eye rubbing, Eye rubbing, Male, Morning rubbing, Sleep position, Work rubbing