Keratoconus overview

Overview

Keratoconus is an eye condition where the clear front part of your eye, called the cornea, becomes thin and slowly bulges outward into a cone shape. This changes how light enters your eye and makes your vision blurry or distorted.

Keratoconus is not very common. It affects about 1 in every 2,000 people, though some studies suggest it may be slightly more common.

It most often affects teenagers and young adults, but it can start at any age. Both men and women can get it, and it tends to run in some families.

Symptoms

Common symptoms

• Blurred or distorted vision that is not fixed with glasses
• Increased sensitivity to light and glare
• Frequent changes in your glasses or contact lens prescription
• Seeing 'halos' around lights at night
• Eye strain or headaches from squinting

Symptoms in children

• Children may not notice the gradual vision changes, so parents might see a drop in school performance or frequent eye rubbing
• They might complain of headaches or tired eyes

Symptoms in older adults

• Symptoms can be confused with other age-related eye changes, like cataracts
• Older adults may notice increasing difficulty with night driving or reading

Causes

Main causes

• The exact cause is not fully understood, but it is linked to the cornea getting weaker over time
• Frequent eye rubbing may play a role in making it worse

Risk factors

• Having a family history of keratoconus
• Having certain conditions like Down syndrome, Ehlers-Danlos syndrome, or hay fever
• Chronic eye rubbing, especially from allergies
• Being of certain ethnic backgrounds – it is more common in people of South Asian and Middle Eastern descent

When to see a doctor

See a doctor urgently if:

• Any sudden vision loss or severe eye pain – call your local emergency number immediately
• If you think you have a corneal infection (red, painful eye with discharge)

Book a routine appointment if:

• If you notice your vision getting worse over time, even after getting new glasses or contacts
• If you have difficulty seeing clearly at night or in dim light
• If you frequently need to change your glasses prescription

Diagnosis

An eye specialist will examine your eyes using a special machine called a slit lamp to see the shape of your cornea. They may also use a device that maps the surface of your cornea in detail.

Tests that may be done

• Corneal topography – a scan that creates a 3D map of your cornea's shape
• Slit-lamp exam – a microscope with a bright light to look at your cornea closely
• Measuring the thickness of your cornea (pachymetry)
• Retinal exam to check the back of your eye

What to expect at your appointment

The tests are painless and usually done in the clinic. You will sit in front of a machine and look at a light while it takes images. The results tell the doctor if your cornea is thinning or bulging. You can usually go home right after.

Treatment

Treatment depends on how advanced your keratoconus is. In early stages, glasses or soft contact lenses may be enough. As it progresses, special contact lenses (like rigid gas permeable or scleral lenses) can help. A procedure called corneal cross-linking can strengthen the cornea to stop it from getting worse. In severe cases, a corneal transplant may be considered.

Self-care at home

• Avoid rubbing your eyes – it can make the condition worse
• Use artificial tears or lubricating eye drops if your eyes feel dry or itchy (ask your pharmacist for a brand that is safe for contact lens wearers)
• Protect your eyes from UV light by wearing sunglasses outdoors
• Keep all follow-up appointments with your eye doctor

Medical treatments

Medical treatments are focused on correcting vision and slowing the disease. Options include: custom contact lenses (rigid gas permeable, scleral, or hybrid lenses) that provide a smooth front surface; corneal cross-linking, which uses eye drops and UV light to stiffen the cornea; and in advanced cases, surgical procedures like corneal transplant (replacing part of the cornea with donor tissue). Your eye doctor will recommend the best option for your specific situation.

When is surgery considered?

Surgery, such as a corneal transplant, is usually only considered when vision cannot be corrected with contact lenses or cross-linking is no longer effective. It is a last resort and most people do not need it.

Living with this condition

Living with keratoconus means working with your eye doctor to find the best vision correction for you. You may need to get used to wearing special contact lenses, which can take some practice. Regular check-ups are important to monitor any changes.

Lifestyle tips

• Do not rub your eyes – if you have allergies, treat them to reduce itching
• Wear protective eyewear during sports or activities that could injure your eyes
• Use good lighting when reading or doing close work
• Tell your employer or school if you need accommodations for vision (e.g., larger screens, breaks for eye comfort)

Diet and exercise

There is no special diet proven to stop or reverse keratoconus, but eating a balanced diet rich in vitamins A, C, and E may support overall eye health. Exercise is fine, but avoid activities that involve heavy eye pressure or risk of eye injury.

Mental health and emotional wellbeing

Having a progressive eye condition can be frustrating and may lead to anxiety or low mood, especially if it affects your daily activities or independence. It is normal to feel this way. Talk to your doctor or a mental health professional if you are struggling.

Prevention

Keratoconus cannot be prevented, but early diagnosis and treatment can slow its progress and preserve vision. Avoiding eye rubbing is the most important step you can take to reduce the risk of worsening the condition.

Complications

If left untreated

• Progressive vision loss that cannot be corrected with glasses or standard contact lenses
• Corneal scarring, which can cause permanent vision problems
• A condition called corneal hydrops, where fluid builds up in the cornea causing sudden pain and vision loss (this is an emergency)

Long-term outlook

Most people with keratoconus can maintain good vision with proper treatment. Advances in contact lenses and the cross-linking procedure have greatly improved outcomes. Even if you need a corneal transplant, the success rates are high. With regular care, you can lead a full and active life.

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