What is Keratoconus? Causes, Symptoms, and Treatment

If you find yourself getting more than the usual number of eyeglass prescriptions or your eyes are occasionally light sensitive, then it’s time to have a conversation with your vision specialist because there is an outside chance you have a very unusual but fixable problem.

Keratoconus is a progressive condition that hinders vision by thinning the cornea and causing malformations on the corneal surface. The Office of Rare Diseases of the National Institute of Health considers it a rare disease. It does not seem to affect any gender, race or age group more than others.

What Is Keratoconus?

Keratoconus is a progressive condition that affects the eyes by thinning the cornea and causing malformations on the cornea’s surface. You can expect it to develop on both eyes, but it will have a greater effect on one eye more than the other.

Keratoconus in at least one eye has a 0.7 to 1.9 percent prevalence.

The Office of Rare Diseases of the National Institute of Health

The cornea is the dome-shaped surface at the front of the eye. It is made up of collagen, which is water and protein. Collagen is responsible for giving the cornea its regular shape.

When Keratoconus develops, it creates a thin cornea with a cone-shaped bulge, leading to vision loss. Typically, the condition can start at puberty and continue into your mid-30s. It is impossible to tell how quickly it will progress once it starts.

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Causes

So far, researchers assume that Keratoconus is hereditary or perhaps a congenital disability that takes time to show itself. Imbalances in cornea tissue production and destruction rate cause the thinning of collagen in the eyes.

Connective tissue disorders such as Marfan syndrome and Ehlers syndrome can cause Keratoconus.

Studies have also found it is associated with excessive eye rubbing, often triggered by allergies. In that case, it is dubious whether allergies or vigorous rubbing of the eyes is responsible for causing Keratoconus.

In addition to being a possible cause, eye rubbing can accelerate the disease. Poorly fixed contact lenses have also played a role in causing Keratoconus.

Symptoms

One giveaway symptom of Keratoconus is irregularly shaped corneas that appear to bulge away from the eye socket. It takes time to notice this symptom. Also, blurred or distorted vision may accompany the condition.

Be on the lookout if you start requiring frequent eyeglass prescriptions, but if you are seeing a vision specialist it is extremely likely they will spot an irregular cornea. The condition may also cause you to develop light sensitivity. Other times, you will get eye irritation accompanied by pain.

Risk Factors

You are at a higher risk of developing Keratoconus if you have a genetic disposition to the disease. It is usually while as a teenager when the condition is likely to develop, which brings with it a risk.

Persistent eye rubbing may cause the disease to advance. Also, allergies and irritants can destroy the corneal tissue, leading to Keratoconus.

Diagnosis

Eye care professionals usually perform various tests to diagnose Keratoconus. The assessments typically focus on the cornea, including: 

• Corneal topography done through computerized imaging to map the shape of the cornea
• Measurement of valves
• Retinoscopy
• Pachymetry, which measures the thinnest areas of the cornea
• Slit-lamp exam can find abnormalities on the layers of the cornea

Treatment Options

The approach taken to manage the condition depends on what stage it is when it doctors detect and diagnose it and how severe it is.

Early Stages

Treatment in the early stages may start with applying soft contact lenses to correct astigmatism. If the condition progresses, the doctor may prescribe hard contact lenses.

Intermediate Stages

In this progressive stage, cross-linking is the most effective method of treating the condition. It involves applying vitamin B solution to the eye and subjecting it to ultraviolet light for 30 minutes for activation.

Vitamin B enhances the formation of new collagen tissue to try and fortify the cornea. Also, ophthalmologists may combine cross-linking and implantable intrastromal ring segments, known as intacs, for better results.

Advanced Stages

There are two optional treatments used to treat advanced stage Keratoconus. One is a corneal ring instead of a standard contact lens. A corneal ring flattens the surface of the cornea, improving eyesight.

The other is a corneal transplant, which requires a donation and replacement of the cornea. It is not as frightening as it might sound because it is not an invasive procedure and usually performed as an outpatient.

Complications with Keratoconus

Advanced keratoconus can cause your cornea to become scarred, particularly where the cone is most prominent.

Mayo Clinic

Corneal hydrops is one of the most severe complications of Keratoconus. It is when the cornea breaks at the weakest point, causing the fluid in the eye to flow abnormally. You would likely experience severe pain, swelling, and eventually, vision loss. Expect the complication to go away on its own after a few weeks, especially after wearing contact lenses.

Prevention

The best way to prevent the condition is taking precautions to minimize the causes. You can start by not rubbing your eyes and ensuring that you wear contact lenses that fit correctly. Additionally, you can look into getting sunglasses to protect your eyes from UV radiation. Treating eye issues as soon as they show up can help ease discomforts caused by allergies.

FAQs

Can you go blind from Keratoconus?

It is rare to go completely blind from Keratoconus, but there is still a possibility of having terrible eyesight to levels that affect your life. In cases of extensive scarring on the cornea, possibly from too much rubbing, it can lead to legal blindness, which requires a corneal transplant.

Can you fix Keratoconus?

Although it is impossible to cure the condition completely, there are ways to manage it. Rigid gas permeable contact lenses can help manage mild cases of Keratoconus, and there are ways to manage severe cases. One thing to keep in mind is the earlier the better when it comes to treatment.

Is Keratoconus serious?

Keratoconus has the potential to cause severe vision loss, so it is fair to say it is a serious condition that deserves the attention it receives. Moreover, it is a lifelong disease that will not go away if you don’t take measures to manage it.

References

1. Keratoconus. (August 2019). Cleveland Clinic.

2. Astigmatism. (December 2020). Cleveland Clinic.

3. Cornea Transplant. (February 2018). Cleveland Clinic.

4. Keratoconus. (2021). American Optometric Association.

5. Risk Factors of Keratoconus in Israel: a case-control study. (2014). American Academy of Optometry.

6. What Causes Keratoconus? (October 2021). American Academy of Ophthalmology.

7. Effectiveness of Intrastromal Corneal Ring Implantation in the Treatment of Adult Patients with Keratoconus: A Systematic Review. (January 2019). Journal of Refractive Surgery.

8. Keratoconus. (April 2021). American Academy of Ophthalmology.

9. Acute Corneal Hydrops. (2021). American Academy of Ophthalmology.

10. Prevalence of Keratoconus Based on Scheimpflug Imaging. (August 2020). American Academy of Ophthalmology.