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Keratoconus
Keratoconus
Nomenclature
From Greek
kerato = cornea
conus = cone-shape
Definition
Keratoconus(KC)
Is a non-inflammatory condition of
the cornea in which there is
progressive central thinning of the
cornea changing it from dome-shaped
to cone-shaped.
Pathophysiology
All layers of the cornea are believed to
be affected by KC, although the most
notable features are the thinning of the
corneal stroma, the ruptures in the
Bowman layer, and the deposition of iron
in the basal epithelial cells, forming the
Fleischer ring.
Onset of keratoconus
It can be anywhere between the ages
of 8 and 45.
In the majority of cases, it becomes
apparent between the ages of 16 and
30 years.
Classification
Based on severity of curvature
Based on the shape
Etiology
1. Heredity
2. Eye rubbing
3. Contact lenses wear
4. Hormonal change
Is keratoconus hereditary ?
While most patients with keratoconus
have no relatives suffering from the
disorder, many have relatives with high
astigmatism and this may be a very
mild form of keratoconus.
Heredity
Eye rubbing
especially children due to some disease as
vernal keratoconjunctivitis
So corneal curvature will be changed
Hormonal change
Nearsightedness
Astigmatism
Blurred vision - even when wearing
glasses and contact lenses
Glare at night
Light sensitivity
Frequent prescription changes in
glasses and contact lenses
Eye rubbing
Diplopia or polyopia.
Apical scarring
(scarring at the apex of
the cone).
Corneal thinning :
In advanced cases,
the thinning of the
central cornea can
be seen on
examination.
Diagnosis
Visual Acuity :
Reduced visual acuity due to oblique
astigmatism
Retinoscopy :
scissor reflex
Ophthalmoscopy :
Oil droplet
Munson's sign:
Its an angulation of the lower lid
during inferior gaze due to corneal
protrusion
The topography of
keratoconus:
The photokeratoscope or placido disc
can provide an overview of the
cornea and can show the relative
steepness of any corneal area.
Treatments
Glasses:
In mild or early keratoconus, glasses
can be used for vision correction.
Unfortunately, as keratoconus
progresses, the irregular shape of
the cornea cannot be corrected with
glasses.
Contact Lenses:
Soft
contact lenses
Contact Lenses:
Soft contact lenses
may be worn with early or mild keratoconus.
Since soft contact lenses conform to the
shape of the cornea.
They are not able to eliminate visual
distortion created by the irregular shape.
For this reason, patients usually require the
use of a rigid contact lens.
Surgical Intervention
A variety of surgical procedures are
available for patients with keratoconus.
Penetrating keratoplasty is the most
common.
Recently, less invasive procedures, such as
Intacs, have been developed
Penetrating keratoplasty:
In this procedure, the central area of the
cornea is excised and a full-thickness
corneal button is sutured into the recipient.
Lamellar keratoplasty:
A partial thickness portion of the cornea is
excised and a partial thickness donor corneal
button is sutured into the recipient transplant.
Phototherapeutic Keratectomy
(PTK):
Excimer laser procedures can remove
superficial corneal scars.
PTK is often helpful in rigid contact lens
wearers who have developed a central scar.
These scars can reduce vision and irritate
the cornea via mechanical rubbing
So PRK
It is used to reduce the steepness of the
cone.
This resurfacing reduced astigmatism and
increased visual acuity
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