14415 Keratoconus

Overview

Keratoconus is an eye condition in which the clear, round front part of your eye (the cornea) becomes thin and bulges outward into a cone shape. This changes the way light enters the eye, causing blurry and distorted vision. The word 'keratoconus' comes from Greek words meaning 'horn' and 'cone'.

No, keratoconus is not very common. It affects about 1 in every 2,000 people, though the number may vary depending on the country.

Keratoconus usually starts in the teenage years or early 20s and may get worse over time. It affects people of all backgrounds, but you may be at higher risk if someone in your family has it or if you have certain conditions like allergies or Down syndrome.

Symptoms

Common symptoms

• Blurry or distorted vision
• Increased sensitivity to light
• Difficulty seeing at night
• Seeing halos or ghost images around lights
• Frequent changes in your glasses or contact lens prescription
• Mild eye irritation or eye strain

Symptoms in children

• Children may not complain about vision problems, so pay attention to squinting, rubbing eyes, or trouble reading the board at school.
• Blurry vision that does not improve with glasses
• Complaints of 'double vision' or 'trails' behind moving lights

Symptoms in older adults

• Symptoms are similar to adults, though the condition may progress more slowly with age.
• Older adults may also have other eye problems like cataracts, which can make keratoconus harder to notice.
• A sudden change in vision should always be checked by an eye doctor.

Causes

Main causes

• The exact cause is not fully understood, but keratoconus happens when the cornea becomes weak and thin.
• Genetics likely play a role – it can run in families.
• Eye rubbing is strongly linked to keratoconus and can speed up the thinning.
• Some studies suggest a link to allergies, asthma, or eczema, but more research is needed.

Risk factors

• Having a family history of keratoconus
• Being in your teens or early twenties
• Chronic eye rubbing, especially from allergies
• Having certain conditions such as Down syndrome, Ehlers-Danlos syndrome, or Marfan syndrome
• Wearing poorly fitted contact lenses for a long time (this does not cause keratoconus, but it can irritate the eye and lead to rubbing)

When to see a doctor

See a doctor urgently if:

• If you have sudden severe eye pain or a sudden loss of vision, get urgent medical help.
• If you have an eye with redness, discharge, or swelling, see your doctor or eye specialist the same day.
• If you wear contact lenses and have any pain or discomfort, stop wearing them and contact your eye care professional immediately.

Book a routine appointment if:

• See an optometrist or ophthalmologist for a thorough eye exam at least once a year.
• If you already have keratoconus, follow your specialist's advice about how often to have check-ups.
• If you notice gradual changes in your vision, book an appointment rather than waiting for your next routine visit.

Diagnosis

Keratoconus is diagnosed during an eye examination. Your eye doctor will ask about your symptoms, check your vision, and use special instruments to see the shape and thickness of your cornea. They may also map the surface of your eye.

Tests that may be done

• A standard eye chart test to check how well you see
• A slit-lamp exam to look at the front of your eye in detail
• Corneal topography, which creates a detailed map of your cornea's shape
• Corneal pachymetry to measure how thick your cornea is

What to expect at your appointment

These tests are simple and painless. You may need to keep your chin on a rest while a machine scans your eye. Your doctor will explain the results and talk about what they mean for your vision. You may need more than one visit to track changes over time.

Treatment

There is no cure for keratoconus, but many treatments can improve vision and slow or stop the condition from getting worse. The right plan for you depends on how advanced your keratoconus is and what your eyes need.

Self-care at home

• Do not rub your eyes – this is one of the most important things you can do.
• If you have allergies, treat them to reduce the urge to rub.
• Protect your eyes from sunlight with sunglasses, especially if you spend a lot of time outdoors.
• Keep all appointments with your eye doctor for regular monitoring.

Medical treatments

In early stages, glasses can correct blurred vision. As the cornea changes shape, special contact lenses – such as rigid gas permeable lenses, scleral lenses, or hybrid lenses – may be needed for clearer vision. Another common treatment is corneal cross-linking, which uses special eyedrops and ultraviolet light to strengthen the cornea and slow the disease. Some people may benefit from small device implants called corneal ring segments, which flatten the cornea and improve vision. These treatments are decided individually by an eye specialist.

When is surgery considered?

If your vision cannot be corrected with lenses or your keratoconus keeps getting worse despite cross-linking, a corneal transplant may be recommended. This is surgery to replace your damaged cornea with a healthy donor cornea. It is usually saved for severe cases, and most people recover well after a transplant.

Living with this condition

Living with keratoconus means staying on top of your eye health. Check your vision regularly, wear your lenses as recommended, and keep your eyes clean and moist. If you wear contact lenses, clean and store them properly to avoid infection.

Lifestyle tips

• Stop rubbing your eyes – make this a daily habit, even when they feel itchy.
• If you have allergies, work with your doctor to manage them.
• Wear sunglasses outdoors to reduce light sensitivity and protect your corneas.
• Let your eye doctor know about any new medication you take, as some can affect your eyes.

Diet and exercise

A generally healthy diet with plenty of fruits and vegetables supports eye health. There is no special diet for keratoconus, but staying well-hydrated and exercising normally are good for your overall health. Always ask your doctor before starting new supplements.

Mental health and emotional wellbeing

Dealing with changing vision can be frustrating, stressful, or upsetting. It is normal to feel worried or anxious. If you are feeling low, speak to your healthcare team – they can give you support and connect you with counselling services.

Prevention

There is no sure way to prevent keratoconus because its exact cause is unknown. However, not rubbing your eyes and managing allergies may help prevent it from getting worse or possibly reduce your risk.

Screening programmes

Routine eye exams are important. If keratoconus runs in your family, tell your eye doctor – they may wish to check your eyes more closely, even before symptoms appear.

Complications

If left untreated

• Progressive blurring and distortion of vision that is harder to correct
• Scarring of the cornea, which can cause permanent vision loss
• Corneal hydrops – a sudden buildup of fluid in the cornea causing severe pain and sudden vision drop
• Increased difficulty with everyday tasks like reading, driving, or working

Long-term outlook

With today's treatments, the outlook for keratoconus is very encouraging. Most people can achieve good vision with glasses or contact lenses, and newer treatments like corneal cross-linking can stop the disease from worsening. Even in advanced cases, surgery has excellent success rates. Regular care and following your doctor's advice give you the best chance of keeping your sight.

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