Mr. B.C is a 29-year-old man with no previous ophthalmic history, no known allergies or any history of keratoconus in the family. He complained of a progressive decrease in visual acuity, greater in the right than in the left eye, which was not correctable with a change of glasses. He has never worn contact lenses.
His Refraction at the first visit (on 10/25th/2016) was : RE 20/20 +0,75 (-3 x 45 °) and LE 20/20 -0,5 (-1,25 x 150 °).
Clinical examination with the slit lamp revealed a discrete irregular inferior corneal bulge in both eyes. The eyes were dry as well, with break up time < 8 seconds.
When asked about his working habits, the patient declared that he worked for long hours in front of the computer screen, and had been doing overnight shifts for the last 4 years. He admitted that he rubbed his eyes a lot to relieve visual fatigue. His right eye was generally more uncomfortable and irritable as it was prone to recurrent chalazia (a chalazion is a swelling in the eyelid due to a blocked meibomian (oil) gland). He rubbed with both fists using grinding and rotatory movements, with the knuckles in direct contact with the eyelids.
He is right-handed and sleeps preferentially on the right side.
We urged him to stop rubbing his eyes definitely and treated his dry eye problem with lubricants.
At his subsequent review a month from the first visit, he verbalized that he was rubbing his eyes more often and more vigorously than he had realized at the first visit.
This case reveals that eye rubbing can often be associated with long hours of overnight shifts and/or time spent in front of the screen, which causes visual fatigue associated with dry eye (reduced blinking). These sensations are often relieved (transiently) by eye rubbing, which as described by patients, can be pleasurable and relaxing in such circumstances. These repeated and sustained frictions are over the long-term are responsible for a pathological permanent warpage of the cornea, culminating in the condition called « keratoconus ». Rubbing with the fists and knuckles is particularly detrimental to the corneas, because the knuckles are the hardest part of the hands.
Cessation of eye rubbing and treatment of the underlying dry eye are sufficient in such cases.