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Keratoconus

Keratoconus is a progressive, non-inflammatory condition characterized by thinning and ectasia of the cornea, typically presenting in puberty to early adulthood. It is associated with genetic predisposition, eye rubbing, and various systemic conditions, leading to symptoms like blurred vision and frequent changes in prescription. Management options range from glasses and contact lenses to corneal cross-linking and surgical interventions in advanced cases.

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2 views3 pages

Keratoconus

Keratoconus is a progressive, non-inflammatory condition characterized by thinning and ectasia of the cornea, typically presenting in puberty to early adulthood. It is associated with genetic predisposition, eye rubbing, and various systemic conditions, leading to symptoms like blurred vision and frequent changes in prescription. Management options range from glasses and contact lenses to corneal cross-linking and surgical interventions in advanced cases.

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iamamedwarrior
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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KERATOCONUS – High-Yield Review (General Ophthalmology)

Definition

●​ A progressive, non-inflammatory thinning and ectasia of the central or paracentral


cornea, leading to a cone-shaped protrusion and visual distortion.​

Epidemiology

●​ Onset: Puberty to early 20s​

●​ Bilateral in >90% cases but may be asymmetric​

●​ More common in atopic individuals and those with habitual eye rubbing​

Etiology / Risk Factors

●​ Genetic predisposition (family history)​

●​ Eye rubbing (especially in atopic dermatitis or allergic conjunctivitis)​

●​ Associated systemic conditions:​

○​ Down syndrome​

○​ Marfan syndrome​

○​ Ehlers-Danlos syndrome​

○​ Osteogenesis imperfecta​

○​ Leber congenital amaurosis​

Clinical Features

●​ Progressive myopia and irregular astigmatism​

●​ Blurred or distorted vision​

●​ Frequent changes in spectacle prescription​


●​ Monocular diplopia or ghosting​

●​ Photophobia, glare, and eye strain​

Signs on Exam

●​ Scissoring reflex on retinoscopy​

●​ Oil droplet reflex on red reflex​

●​ Fleischer ring: Iron deposition around the base of the cone (seen on slit-lamp)​

●​ Vogt's striae: Fine vertical lines in the deep stroma​

●​ Munson's sign: V-shaped deformation of the lower eyelid on downgaze (advanced


cases)​

Diagnostic Tools

●​ Corneal topography: Gold standard; shows inferior steepening and irregular


astigmatism​

●​ Pachymetry: Measures corneal thinning​

●​ Keratometry: Detects steepening of the corneal curvature​

Differential Diagnosis

●​ Pellucid marginal degeneration​

●​ Keratoglobus​

●​ Post-LASIK ectasia​

Management

●​ Early stage:​

○​ Glasses or soft toric contact lenses​

●​ Moderate stage:​
○​ Rigid gas-permeable (RGP) contact lenses​

○​ Scleral or hybrid lenses​

●​ Corneal collagen cross-linking (CXL):​

○​ Halts progression by strengthening corneal collagen​

●​ Advanced cases:​

○​ Intrastromal corneal ring segments (ICRS) (e.g., Intacs)​

○​ Corneal transplant (Penetrating keratoplasty or Deep Anterior Lamellar


Keratoplasty - DALK)​

Complications

●​ Hydrops: Acute rupture of Descemet's membrane → corneal edema and sudden vision
loss​

●​ Scarring: Leading to permanent visual impairment​

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