Patient right profile
Mr. X.F is a 20-year-old male 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.
His refraction at the first visit at the Rothschild Foundation (on 01/05th/2018) was : Right Eye (RE) 20/32 with +0.25 (-3.50 x 70 °) and Left Eye (LE) 20/25 with -0.5 (-2.75 x 115 °).
Clinical examination with the slit lamp suggested thin and irregular corneas, especially in the right eye.
Corneal topography performed at our institution showed the presence of bilateral keratoconus, more pronounced in the right eye.
During the first visit, the patient denied rubbing his eyes. We advised him to be more aware of his habits, as eye rubbing is a subconscious activity in many individuals.
At his next visit, he was accompanied by his mother, who revealed to us that her son was a habitual eye rubber. The patient, having been primed to the fact that he was subconsciously rubbing his eyes, spontaneously demonstrated how he would rub his eyes, especially the right, just before sleep to relax himself. He shared with us that having changed jobs, where the environment was very dusty, he found himself rubbing his eye very frequently at work as well.
The patient is right handed and rubs his right eye with his right hand. He sleeps on his right side, with the head buried in the pillow (pillow hugging).
We explained to him that since vigorous eye 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 avoid rubbing his eyes and to change his unhealthy sleeping position. We also prescribed him an eye shield to be worn at night, and artificial tears to relieve dry eye symptoms which could trigger the pruritus (itch).
Fortunately, the patient complied with our instructions. To relieve ocular itch, he describes how he modified his eye rubbing technique, by avoiding direct contact and force on the cornea (watch the video below).
Here are pictures of the patient rubbing his eyes and his profiles
Patient showing how he rubs his eyes
Patient demonstrating his new technique to avoid eye rubbing
In this case, we find many triggers for eye rubbing like exposure to dust and night-time ocular compression from an unhealthy sleeping position. The asymmetric nature of keratoconus development is related to the sleeping position (right sided) and the habit of preferentially rubbing the right eye. Once again, the technique of eye rubbing is directly related to the severity of keratoconus. Rubbing with the knuckles, the hardest part of the hands, is particularly detrimental, as it inflicts severe biomechanical stress on the cornea.
An interesting point of note is that through numerous patient testimonials on this site, initiation of the eye rubbing habit often begins shortly after a change of profession, especially when the environment concerned is filled with dust and irritants, or if the job requires long periods of intensive work. In the younger patients, long hours preparing for exams can be a triggering factor.
It is very important to spend time with the patient to elucidate the need for eye rubbing. Often the answers are not apparent at the first consultation, because the patient is not always conscious of the habit. Hence the importance of re-interrogating the patient at each consultation to make him aware of his rubbing habits.
The presence of relatives is often useful because it allows the patient to better realize at which moments he rubs his eyes.
Fortunately, the cessation of eye rubbing resulted in a stabilization of the corneal deformation in this patient’s case, with no progression of the keratoconus.
Other cases :
- Date 1 avril 2018
- Tags Asymmetric, Bilateral keratoconus, Dry eyes, Eye rubbing, Inferior keratoconus, Knuckles rubbing, Male, Night shift, Pillow hugging, Sleep position, Stabilization, Witness, Work rubbing