Keratoconus Symptoms, Causes, Treatment and Prevention

Keratoconus is a degenerative eye condition characterized by thinning of the cornea. Even more, it changes its symmetrical dome shape to such a limit that it becomes like a cone. Over time, this results in a person experiencing blurred and distorted eyesight. In worst cases, vision loss may occur, too. Worry not – we are here to guide you about the possible treatment options to correct keratoconus. So, keep reading until the end!

Eye care providers typically find keratoconus during your teenage years or your 20s and 30s, but it can also start in childhood. In some cases, a provider will diagnose a mild case of keratoconus at a later age. The changes in the shape of the cornea occur over many years but happen more rapidly in younger people.

Keratoconus: A General Overview

The cornea is the transparent part of the frontal eye surface, having a convex shape. It is located centrally and is responsible for adequately focusing the incident light rays. Plus, it protects the eye, helping to maintain a clear focus. However, in keratoconus, the cornea bulges outward into an asymmetrical or crooked cone, hampering light refraction. The images thus formed appear hazy and out of focus to our eyes. Standard treatment methods include corrective glass prescription and surgical procedures. We will discuss each of them shortly after.

How common is keratoconus?

Keratoconus is a rare optical condition affecting 1 out of 2000 individuals globally, most of whom are young adolescents. It progresses in the middle thirties, deteriorating eyesight with time. The symptoms are, however, more aggressive in children. In this context, you must know that it is the most common cause of corneal dystrophy in America alone!

Keratoconus: What are the types?

Depending on the shape and location of cornea thinning, keratoconus is classified into five major types. There are as follows:  

  • Nipple or round cone: A small cornea region is affected by this, characterized by a steep slope. Over time, vision declines.
  • Oval or sagging cone: A significant part of the cornea is involved, associated with a rupture of its internal membranes. This results in tissue scarring and difficulty in accommodating contact lenses.
  • Forme fruste: It often remains asymptomatic and is mild upon exhibiting symptoms. Mapping of eye surfaces helps detect such a condition.
  • Keratoglobus: It is the rarest form of keratoconus in which the entire cornea is affected.
  • Pellucid marginal degeneration: The lower portion of the cornea is affected, gradually causing it to thin out and protrude.

Signs and symptoms associated

The key sign of keratoconus is when the cornea thins to the extent that it loses its natural dome shape. In the early stages, it is nearly impossible to detect; however, as time progresses, you will likely experience vision problems. Here's a list of some early symptoms of keratoconus.

  • Rizzuti sign: It is characterized by a steep-curved reflection as if a bright light is shining close to your cornea.
  • Fleischer ring: A reddish-brown ring of iron deposit surrounds the cornea in this. This can be visualized with a cobalt blue filter.   
  • Vogt's striae: Elongated lines appear on the cornea that generally disappear with time. If you see this type of vertical line, you can apply firm pressure to your eyes.

Apart from the above symptoms, you may also experience the following:

  • Swelling of the cornea
  • Increased sensitivity to light
  • Appearance of glares and halos near your vision field
  • Persistent eye strain
  • Irritability in the eyes (associated with frequent urge to rub them)
  • a persistent desire to rub your eyes
  • Night-blindness
  • Myopia or nearsightedness difficulty seeing distant objects
  • Irregular astigmatism (characterized by uneven eye curvature)

Sometimes, you may also develop corneal blisters. These can lead to tissue scarring and swelling. Apart from this, an uncommon complication may arise, known as acute corneal hydrops. It causes an abrupt swelling in response to a ruptured Descemet membrane underneath the cornea.

Keratoconus: Possible Causes Explained

It is a complicated question, and researchers have yet to find a suitable answer to this.  Arguably, it is thought to occur due to genetic factors. This is true to a certain extent, but environmental factors can also trigger it.

  • Family history: Certain people who suffer from keratoconus are thought to carry parental genes. Such genetic predisposition can lead to an increased risk of developing this condition when triggered by certain environmental factors.
  • Underlying disorders: Keratoconus sometimes results from certain underlying disorders, such as sleep apnea, asthma, Down's syndrome, brittle cornea syndrome, etc. Marfan syndrome and Leber congenital amaurosis can also contribute to keratoconus. However, there is no supporting evidence for this fact.
  • Environmental risk factors: Some environmental triggers, such as harsh eye rubbing, wearing uncleaned lenses etc., can aggravate the likeability of keratoconus development in individuals.

Possible complications for a prolonged untreated Keratoconus

If you leave your condition unchecked, the following complications may arise.

  • Corneal hydrops: It is characterized by corneal swelling. Aqueous fluid starts to enter Descemet's membrane, causing extreme pain and visual disturbance. Generally, it resolves on its own; however, some tissue scarring may occur, affecting eyesight in the long run.
  • Corneal scarring: This happens in the advanced stages of keratoconus when the formed cone is most prominent.  In the worst cases, individuals may need a corneal transplant.
  • Corneal thinning: The cornea is an essential part of the eye, helping in protective and focusing functions. When it thins out considerably, chances of hole formation become high.
  • Contact lens complications: Patients suffering from keratoconus are more vulnerable to face complications due to wearing contact lenses—for example, tissue abrasion and giant papillary conjunctivitis etc. 

Diagnostic procedures for keratoconus

Before your ophthalmologist takes your eye exam, he will ask you a few questions. These include questions regarding your medical past and family history of eye diseases. Your eye doctor can prepare a better treatment plan by collecting all this information. Below is a comprehensive list of all the standard diagnostic procedures that are involved.

  • Visual acuity: It involves making the suspected individuals read out the letters from Snellen's chart. Also, an instrument called a phoropter is implemented in the process. This helps in finding the right eye prescription for enhanced vision.
  • Slit lamp examination: This test uses a microscope equipped with a bright light capable of maintaining a focus of a thin beam. It allows the ophthalmologist to examine the eye structures, from front to back, such as the cornea, iris, retina, etc.
  • Keratometry: This test is responsible for measuring cornea shape and determining the presence of structural abnormalities.   
  • Corneal mapping (also known as tomography or topography): These tests help measure the curvature of the cornea or 'map' its surface, acting as a confirmative indication of keratoconus.

How do you treat keratoconus?

The ophthalmologist will decide on the treatment programme depending on the intensity of your eye condition. Common treatments include corrective glasses and contact lenses, corneal crosslinking, implantable ring segments, and, at times, a corneal transplant. Here's a detailed explanation of each.

Eyeglasses and contact lenses

These are beneficial during the early stages of keratoconus. However, a deteriorated condition may not be solved with these corrective methods. This is because irregular astigmatism may set in by then.

Corneal crosslinking

It is a UV-ray-induced treatment to decelerate or prevent deterioration of keratoconus. During this procedure, your eye care provider will put a small amount of eyedrops containing riboflavin (or Vitamin B2), which must be kept for at least thirty minutes. After that, the eyes are subjected to ultraviolet rays for the same duration. Let's explain the mechanism behind this. Employing UV rays helps strengthen the bonds between the collagen fibers and surrounding proteins, maintaining normal corneal shape.

Implantable ring segments (INTACS)

These are minute devices that your ophthalmologist inserts within the cornea. They help improve vision and ease the process of fitting contact lenses. Local anesthesia is given prior to the procedure, after which small channels are created. These facilitate the easy insertion of the implantable rings. Such rings help flatten the cornea and gradually correct the cone shape formed due to keratoconus.

Cornea transplant

It is helpful to rectify the more advanced stages of keratoconus. In this procedure, the eye doctor surgically replaces your diseased cornea with a healthy piece of corneal tissue (obtained from a human donor). Typically, people suffering from keratoconus give positive feedback after getting a corneal transplant. However, this process may take a year or more to stabilize vision. Some people may even need a specialized contact lens after completion of the transplantation procedure. This enhances visual acuity.

If you find trouble to see things clearly, we are more than happy to help. Arrange an appointment with our optometrist and get early treatment.

Is it possible to correct it completely?

Well, it is not. At the maximum, timely treatment can prevent and manage the deterioration of keratoconus. In simple terms, the faster you can obtain an early diagnosis, the easier it is to preserve your sight.

How frequently do you need optical exams to prevent keratoconus?

It is better to get optical exams at least two times a year to effectively monitor and prevent keratoconus progression. During these exams, your eye doctor will conduct corneal topography, which allows you to track any minute changes in the cornea's curvature. Such an early diagnosis helps in personalized treatment.

Homely Tips for Managing Keratoconus

Although keratoconus is a degenerative disorder, it does not resolve quickly upon setting in. However, following the measures below can help manage it effectively.

  • Avoid rubbing the eyes: Rubbing the eyes is one of the most significant reasons for worsening keratoconus. So, do not rub the eyes even if they feel itchy. Instead, use clean and cold water to wash them.
  • Use protective eyewear whenever you go out: This is very useful for shielding the eyes against harmful UV rays from the sun. Sunglasses are considered to be the best option for this—consider wearing them even on cloudy days.
  • Manage allergies: If you are allergic to a potential substance, avoid it. Allergy can cause severe eye rubbing, thus deteriorating keratoconus.
  • Hydrate your eyes enough: Using a lubricating eye drop regularly can help keep the eyes moist, preventing dryness and irritation.
  • Have a diet rich in Omega-3s: A good example of omega fatty acids, omega-3 is an essential micronutrient that enhances eye health. Some examples of foods that contain omega-3 are fatty fish, walnuts, flax seeds etc.
  • Maintain proper care of your contact lenses: If you wear contact lenses, ensure they fit correctly in your eyes. Also, do not forget to maintain proper hygiene, as this may lead to irritation.

When do you need to visit the doctor?

Treat keratoconus as a priority if you experience sudden vision changes like glares, halos, image distortions, blurriness, etc. Moreover, you can facilitate early detection and timely treatment with routine eye exams.

Conclusion: Cure your eyes with our trained ophthalmologists today!

Keratoconus is considered a chronic, non-inflammatory disorder of the corneal tissue. Typically, it starts during early adulthood; however, it may sometimes even set in at a much earlier or later life phase. You do not need to worry because we have a good solution for you. Guess what? At Vision Cure Clinic, we provide a wide range of treatment options, besides general eye checkups to treat keratoconus. So, delay not and embark on your journey to obtaining the best care for optimal vision clarity from now on!

Frequently Asked Questions (FAQs)

Keratoconus does affect vision; however, this does not mean you cannot enjoy a normal life. A simple reminder: Attend regular optical follow-ups and have regular tests to monitor your condition, and you are good to go!

Genetic testing is a very useful tool in planning personalized treatment plans that can give optimal results. It also aids in timely procedures like corneal crosslinking, etc. Last but not least, when you know about your genetic disposition, the risk of developing keratoconus in your future generation decreases.

The risk of turning blind is very rare. General preventive measures can help manage such a condition; however, be careful if you are in more advanced stages. You may lose a considerable amount of your vision in this case.

If you experience a sudden vision loss or extreme pain in the eyes, you must treat your condition as an emergency. Also, in cases where you had an operative procedure in your eyes and now have visible signs of infection, such as optical discharges, you must seek immediate medical help.

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