Keratoconus: Causes, Diagnosis, and Treatment

What is Keratoconus?
Keratoconus is a progressive eye disorder in which the normally round cornea becomes thin and gradually bulges outward into a cone shape. This abnormal shape prevents light from focusing properly on the retina, leading to distorted vision. The condition typically begins in adolescence or early adulthood and may progress for 10–20 years before slowing down.

Causes of Keratoconus

The exact cause of keratoconus is not fully understood, but several contributing factors have been identified:

• Genetics: A family history of keratoconus increases the risk.
• Chronic eye rubbing: Often linked to allergies or eye irritation, can weaken the cornea.
• Underlying medical conditions: Such as Down syndrome, Ehlers-Danlos syndrome, and asthma.
• Oxidative stress: Imbalance in corneal cells may lead to tissue breakdown.

Symptoms of Keratoconus

• Blurred or distorted vision
• Increased sensitivity to light and glare
• Frequent changes in eyeglass prescriptions
• Difficulty seeing at night
• Sudden worsening or clouding of vision (in advanced stages)

Diagnosis

Keratoconus can be diagnosed through a comprehensive eye exam using:

• Corneal topography: The most accurate method to map the shape of the cornea.
• Slit-lamp examination: Detects changes in the cornea’s shape and thickness.
• Pachymetry: Measures corneal thickness.
• Keratometry: Measures the curvature of the cornea.

Early diagnosis is key to managing progression and planning treatment.

Treatment Options

Treatment depends on the severity of the condition:

1. Eyeglasses or soft contact lenses: Effective in early stages to correct mild vision problems.
2. Rigid gas permeable (RGP) lenses: Help reshape the cornea for clearer vision.
3. Hybrid or scleral lenses: Provide comfort and improved vision in moderate to severe cases.
4. Corneal cross-linking: A minimally invasive procedure that strengthens the cornea and slows progression.
5. Intacs: Small ring segments inserted into the cornea to flatten and reshape it.
6. Corneal transplant: Required in severe cases when scarring or thinning is advanced.

Prognosis and Outlook

With early diagnosis and proper treatment, many patients can maintain good vision and avoid the need for surgery. Regular follow-up with an eye care specialist is essential to monitor changes and adjust treatment as needed.