Case #91

Mr. LJ is a 24-year-old male with schizoprenia. He has no known family history of keratoconus. He presented to us with a progressive decrease in visual acuity greater in the right eye than the left, as well as frequent redness in both eyes.

His refraction at the first visit at the Rothschild Foundation (on 03/1st/2018) was : Right Eye (RE) 20/32 with -1.25 (-4.25 x 25 °) and Left Eye (LE) 20/32 with +0.50 (-3.00 x 155 °).

Clinical examination with the slit lamp revealed bilateral Vogt’s striae and Fleischer rings (Fleischer rings are pigmented rings in the peripheral cornea, resulting from iron deposition in basal epithelial cells, in the form of hemosiderin. Vogt’s striae are thin vertical streaks located in the posterior corneal stroma (at the level of the Descemet membrane)). We also found superficial punctate keratopathy in the inferior cornea of the right eye, indicating a clinically dry eye.

Corneal topography performed at our institution showed the presence of bilateral keratoconus more pronounced in the right eye.

When asked about the possibility of frequent eye rubbing, the patient admitted to rubbing his eyes in the mornings or at night while watching television, as rubbing gives him a sense of well-being. He has no known allergies. He used to sleep on his right side with his head on the arm. He often awakes in the mornings with bilateral eye redness, more in the right eye than the left. 

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 him to stop rubbing his eyes and to change his unhealthy sleeping position. We also prescribed him an eye shield for the right eye for use during sleep. We treated his dry eyes with artificial tears and vitamin A ointment at night.

At the subsequent visits, the patient informed us that despite being warned of the dangers of eye rubbing, he had difficulty abstaining from rubbing his right eye, as he derived a certain pleasure from rubbing it. He was however able to stop rubbing his left eye on most occasions. He also verbalized having problems keeping the eye shield on at night (it would often come off his face), and he was still sleeping on his right side.

We once again reiterated the dangers of eye rubbing and strongly encouraged this patient to alter his sleep position and to consciously stop rubbing his eyes.