Patient right profile
Mr. F.X is a 34-year-old male music DJ with no any known family history of keratoconus (he has one brother and one sister without keratoconus). He underwent bilateral ptosis in childhood. He complained of a progressive decrease in visual acuity greater in both eyes.
His refraction at the first visit at the Rothschild Foundation (on 04/10th/2018) was : Right Eye (RE) 20/80 with -2.0 (-1.5 x 0 °) and Left Eye (LE) 20/32 with +0.5 (-1.75 x 85 °).
Clinical examination with the slit lamp suggested a thin and irregular corneas with Fleischer ring. Fleischer rings are pigmented rings in the peripheral cornea, resulting from iron deposition in basal epithelial cells, in the form of hemosiderin.
Corneal topography performed at our institution showed the presence of a bilateral keratoconus, more pronounced in the right eye
At the first visit, when asked about the possibility of frequent eye rubbing, the patient admitted to rubbing his eyes when he awoke in the mornings or before sleeping. He used to rub his eyes using his right hand as a forceps, with his thumb rubbing his right eye and his forefinger rubbing his left eye. It gives him a feeling of well being and relieves him of his fatigue. He also spends many hours in front of the computer to do music and works till late in the evening and night.
He is right handed and used to sleep on his stomach, with the head buried in the pillow (pillow hugging)
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 this patient to stop rubbing his eyes and to change his unhealthy sleeping position. We also advise him to adapt his lifestyle and avoid the night shifts, often leading to rubbing his eyes.
Here are pictures of the patient rubbing his eyes and his profiles
In this case, many factors responsible for eye rubbing are present: extended computer work, irregular work schedules with frequent night shifts, and finally an unhealthy sleeping position.
Prolonged work in front of the computer is responsible for dry eye caused by a reduced blinking rate and subsequent increased tear film evaporation. This triggers ocular surface irritation and the desire to rub the eyes. Rubbing neutralizes the irritation and allows a re-lubrication of the ocular surface.
Night-shift work is also associated with dry eye . The lack of sleep is often relieved by eye rubbing which provides a sense of well-being to the patient.
Finally, we observed that the position of sleep is often related to the side of asymmetric cases. The prolonged compression on the eye and orbit may result in a local increase in temperature, and the lack of oxygenation and prolonged contact with the pillow (& allergens) during the night may be responsible for a desire to rub the eyes upon awakening.
All these factors were explained to the patient during his first visit. He stopped rubbing his eyes and changed his sleeping position.
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- Date 23 octobre 2018
- Tags Enjoyed eye rubbing, Eye rubbing, Finger pulp rubbing, Knuckles rubbing, Male, Morning rubbing, Sleep position, Stabilization