A corneal disorder, keratoconus, is a progressive eye condition involving the connective tissue, allowing thinning of the structure that results in alteration from the normal curved shape to a cone shaped cornea. The causes are unknown, but genetic propensity is implicated in these changes with a large number occurring in the South Asian populace and Downs syndrome. Studies show that allergies effecting the eyes are possibly related when the patient develops “eye rubbing” behavior. Treatments for keratoconus give patients a normal, completely functional life.
The hallmark, first symptoms can be subtle blurred vision, common to refractive disease. This condition normally affects both eyes, but can be unilateral. The nature of this corneal degeneration is unpredictable. Generally, first symptoms exhibit in adolescent patients. Sensitivity to light, squinting and itchy eyes with no pain are indicative of this corneal disorder. Vision at night is impaired. The perception of “Ghost” visuals, multiple images, streaks and flares may distort vision in the light. Patients may notice image movement in time with heartbeat.
There are several defining tests to determine this disorder. Slit-lamp examination of the cornea will be necessary. Corneal topography is highly specific for the reshaping process inherent in this condition and is done by mapping the curve of the cornea. This particular condition should not employ laser treatment. Pachymetry is a pain-free test that determines thinning at the point of the conically shaped cornea.
Treatments for keratoconus are varied depending on severity. The most subtle forms benefit from either glasses or soft contact lenses. More typically, patients will probably need to utilize rigid contact lenses to restore perfect vision correction. Patients with advanced disease will require gas-permeable contact lenses to maintain legal driving privileges and visual acuity necessary for reading standard print.
Progressive disease may require surgery in efficacious treatments for keratoconus with intrastromal corneal ring segments, corneal collagen cross-linking or corneal transplantation. High-frequency radio energy can be utilized in corneal ring segments, referred to as corneal implants, that allow the shape of the cornea to be altered for improved vision with contact lenses. Corneal cross-linking hardens the cornea, stabilizing the condition and stopping further progression. This procedure, still experimental, allows corneal reshaping followed by laser vision correction. Severe progression may require corneal transplantation.
Corneal transplantation is reserved for those patients with the most severe presentations of deterioration. Results are generally good. Recovery can be lengthy, however, and patients usually need contact lenses. Rejection risk is much lower than other organ transplants.
In the case of young adults that do not have a perfect vision improvement with glasses needs to be evaluated by a specialist in corneal refractory diseases. There is evidence that unaddressed allergic disease with eye involvement can precipitate the exacerbation of this disease and recommend all patients abstain from rubbing their eyes, although the general consensus is that the disease is not preventable.
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