Patient left profile
Ms. W.W is a 50-year-old female who had bilateral LASIK performed in 1999 for myopia (- 3 D). She was referred to us by an ophthalmologist to evaluate the increasing astigmatism in her left eye since 2014, which was causing a progressive decrease in visual acuity. She had already sought an opinion in another institution, where she was advised to have corneal collagen cross-linking on an urgent basis.
Her refraction at the first visit at the Rothschild Foundation (on 07/11th/2017) was: Right Eye (RE) 20/20 with -1 (-0.5 x 35 °) and Left Eye (LE) 20/25 with -0.75 (-3.75 x 115 °).
Clinical examination with the slit lamp suggested a thin and irregular left cornea. We also found bilateral tarsal papillae (more pronounced in the left eye), and signs of dry eye.
Corneal topography performed at our institution revealed the presence of unilateral post LASIK ectasia in the left eye.
At the first visit, when asked about the possibility of frequent eye rubbing, the patient admitted to rubbing her eyes when she awoke in the mornings and after removing her eye makeup.
With regards to her sleeping habits, she described sleeping on her left side or stomach, with the head buried in the pillow (pillow hugging). She is allergic to dust mites, and shared how her left eye was more often irritated than the right one.
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 corneal ectasia in her case.
We strongly advised this patient to stop rubbing her eyes and to change her unhealthy sleeping position.
At the subsequent visits, the patient informed us that after being primed about the deleterious effects of eye rubbing, she had come to realize that she was rubbing her eyes more often than she had thought initially. She has also since tried her best to alter her sleeping posture.
Here are pictures of the patient rubbing his eyes and his profiles
In this case we find many triggers for eye rubbing like eye rubbing and an unhealthy sleeping position. The unilateral or asymmetric nature of corneal ectasia development may be related to the sleeping position (left sided) and the habit of preferentially rubbing the left eye.
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- Date 14 janvier 2018
- Tags Allergy, Asymmetric, Cross linking, Dry eyes, Ectasia, Eye rubbing, Female, Fleischer ring, Knuckles rubbing, Lasik, Morning rubbing, Oldest, Pillow hugging, Removing makeup rubbing, Sleep position