Patient left profile
Ms. S.G is a 43-year-old female who had bilateral LASIK performed in 2002 for myopia of – 4 DS at another institution. Five years later, she complained of a progressive decrease in visual acuity in both eyes. She had developed astigmatism requiring spectacle correction. As the astigmatism progressively increased, her ophthalmologist diagnosed post-LASIK ectasia and informed her that she required corneal collagen cross-linking.
She was referred to us by another ophthalmologist to evaluate the increasing astigmatism in both eyes, which was causing a progressive decrease in visual acuity. She had already sought an opinion at another institution, where she was again advised to have corneal collagen cross-linking, this time on an urgent basis.
Her refraction at the first visit at the Rothschild Foundation (on 02/07th/2017) was: Right Eye (RE) 20/20 with +1.25 (-4.25 x 70°) and Left Eye (LE) 20/25 with +1 (-3.25 x 105 °).
Clinical examination with the slit lamp suggested thin and irregular corneas. Her eyes were also found to be clinically dry.
Corneal topography performed at our institution revealed the presence of bilateral post LASIK ectasia.
At the first visit, when asked about the possibility of frequent eye rubbing, the patient admitted to rubbing her eyes because they felt dry and uncomfortable. She would rub her eyes very frequently and intensely after the LASIK to relieve this dry eye sensation. She also admitted to rubbing her eyes prior to the LASIK surgery, especially after removal of her eye makeup.
With regards to her sleeping habits, she described sleeping on the side, predominantly on her right side or stomach, with the head buried in the pillow (pillow hugging).
We explained to the patient how vigorous eye rubbing could have induced weakening of her corneas, which were further compromised by the LASIK procedure. Subsequent eye rubbing after the surgery incurred further weakening, culminating in corneal ectasia in both eyes.
We strongly advised this patient to stop rubbing her eyes and to change her unhealthy sleeping position, in order to prevent further aggravation of the post LASIK ectasia.
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 even more often than she had thought initially, sometimes rubbing continuously for several minutes. She has since tried her best to alter her sleeping posture.
Here are pictures of the patient rubbing her eyes and her profiles
Corneal ectasia post refractive surgery is an unusual but potentially severe complication. It corresponds to a biomechanical decompensation of the cornea, which loses its regularity and whose central curvature increases. Consequently, ectasia results in the reappearance of evolutionary myopia and astigmatism. There are several risk factors for post LASIK ectasia. The main risk factor is the presence of an undetected form of sub-clinical keratoconus existing in the unoperated cornea. As with keratoconus, the habit of repeated eye rubbing is also a risk factor, as these frictions have led to the reduction of corneal resistance before surgery, and the cornea is weakened further if rubbing is continued after the operation.
The role of eye rubbing in post LASIK ectasia is probably underestimated. It should be suspected for every case of ectasia, especially in late-onset post-LASIK ectasia. This case is very informative about the risks of eye rubbing before and after LASIK surgery. Unfortuantely, the pre-LASIK topographies were not available in this case.
Following excimer laser ablation in LASIK, the cornea is thinned. The repeated and sustained friction on this thinned cornea afforded by eye rubbing can be particularly detrimental to the biomechanical integrity of the corneal wall and the compressive effect makes it thinner and more irregular. It is interesting to note that the topographic irregularities detected were all more pronounced in the right eye, which was the eye buried in the pillow at night, and the eye that was rubbed more
Finally, post LASIK ectasia can be observed after LASIK in high myopia, when the corneal flap created is too thick and/or the volume of cornea removed too large. Thanks to the femtosecond laser which is used to create the corneal flap in LASIK today, flap thickness predictability is greatly increased and it is now possible to avoid inadvertently cutting an overly thick flap.
You can read about other cases of post LASIK ectasia induced by eye rubbing on this website like : Case 68, Case 67, Case 52, Case 39, Case 27, Case 25 and Case 13.
All these patients have the same story: a history of vigorous and persistent eye rubbing prior to and/or after the surgery.
Other cases :
- Date 15 février 2018
- Tags Allergy, Asymmetric, Childhood rubbing, Computer screen, Cross linking, Dry eyes, Ectasia, Eczema, Enjoyed eye rubbing, Eye shield, Female, Fleischer ring, Knuckles rubbing, Lasik, Morning rubbing, Sleep position, Stabilization, Work rubbing