The cornea is a clear, dome-shaped window in front of your eyes. It focuses the light on your eyes. Keratoconus is when the cornea thins and swells like a cone. You can find more information below.

What is keratoconus?

Keratoconus is an eye disorder in which your cornea becomes thinner over time. In this case, the cornea turns into a cone-like shape.

The cornea is the outer layer of your eye. It is a transparent layer that covers the front of your eye. It helps protect the rest of your eyes from germs and harmful things. It also helps you focus the light on your eyes. With keratoconus, the cornea becomes thinner in the lower and middle parts. This can also cause swelling and scarring of your cornea. These changes in the cornea can cause vision problems such as nearsightedness ( myopia ) and astigmatism .

There are different types of keratoconus. Types are determined depending on the shape and location of the thinned cornea. These types include nipple, oval, keratoglobus, and D-shaped keratoconus.

Who does it affect?

Keratoconus is not a common condition. It occurs in young adults and those in their twenties. It affects men and women equally.

Causes of keratoconus

Experts do not know what causes this eye disorder. Some cases may be partially due to genes. Some health conditions are also linked to this disorder and can cause it. These include:

  • Down Syndrome
  • Ehler-Danlos syndrome
  • Eye injury (especially from too much eye rubbing or wearing contact lenses)
  • Leber congenital amaurosis
  • Osteogenesis is imperfect
  • Retinitis pigmentosa
  • retinopathy of prematurity
  • Vernal keratokonjonktivit
  • Sleep apnea

Who is at risk?

Some factors can increase your risk, such as:

  • Poorly fitted contact lenses in the past
  • Prolonged (chronic) eye rubbing due to eye irritation such as allergies
  • Having a health condition related to keratoconus
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Keratoconus symptoms

Keratoconus causes nearsightedness ( myopia ). This means you have trouble seeing distant objects. It also causes astigmatism to the moon. This is a problem with your eye forming a focused image on your retina. Together, these cause blurred vision .

This eye disorder often causes symptoms in both eyes. One eye may show symptoms before the other. One eye may be more affected than the other.

Symptoms usually begin in adolescence and worsen by age 40. You may not know you have this disorder unless your eye doctor does special tests. Afterward, your vision may get worse. If your vision is getting worse than expected, your doctor may evaluate you for keratoconus.

When should you see a doctor?

If your vision is rapidly deteriorating or your vision is getting blurry, you should consult an ophthalmologist immediately. Your doctor may look for signs of keratoconus during routine eye exams.

Keratoconus diagnosis

To diagnose this eye disorder, your eye doctor will review your medical and family health history and perform an eye exam. He or she may do other tests to determine more details about the shape of your cornea. Tests to diagnose keratoconus include:

  • Eye refraction: In this test, your eye doctor uses special equipment that measures your eyes to check for vision problems. He or she may ask you to look at a device containing different lenses to help determine which combination gives you the sharpest vision. Some doctors may use a hand-held instrument ( retinoscope ) to evaluate your eyes.
  • Slit lamp exam: In this test, your doctor directs a vertical beam of light to the surface of your eye and uses a low-power microscope to view your eye. It evaluates the shape of your cornea and looks for other potential problems with your eye.
  • Keratometry: In this test, your eye doctor focuses a circle of light on your cornea and measures the reflection to determine the basic shape of your cornea.
  • Computerized corneal mapping: Specialized photographic tests such as optical coherence tomography and corneal topography record images of your cornea to create a detailed shape map of your cornea’s surface. The tests can also measure the thickness of your cornea.
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Keratoconus treatment

Treatment for this eye disorder depends on the severity of your condition and how quickly the condition progresses.

Mild to moderate keratoconus can be treated with glasses or contact lenses. For many people, the cornea will stabilize after a few years. If you have this type, you probably won’t have serious vision problems or need further treatment.

In some people with this eye disorder, the cornea becomes scarred or it becomes difficult to wear contact lenses. In these cases, surgery may be required.

lenses

  • Glasses or soft contact lenses: Glasses or soft contact lenses can correct blurred or distorted vision in early keratoconus. However, people need to change their glasses or contact prescriptions frequently as the shape of their corneas changes.
  • Rigid contact lenses: Rigid contact lenses are often the next step in the treatment of progressive keratoconus. Rigid lenses may be uncomfortable at first, but many people adjust to wearing them and they can provide excellent vision. These types of lenses can be made to fit your corneas.
  • Dual lenses: If hard lenses bother you, your doctor may recommend placing a hard contact lens over a soft lens.
  • Hybrid lenses: These contact lenses have a hard center with a softer ring on the outside for added comfort. People who cannot tolerate hard contact lenses may prefer hybrid lenses.
  • Scleral lenses: These lenses are useful for very irregular shape changes in your cornea in advanced keratoconus. Instead of sitting on the cornea like traditional contact lenses, scleral lenses fit on the white part of the eye (sclera).

If you wear rigid or scleral contact lenses, you should make sure they are fitted by an ophthalmologist experienced in the treatment of keratoconus. You should also have and have regular check-ups. An unsuitable lens can damage the cornea.

Other treatments

In a procedure called corneal crosslinking , the cornea is saturated with riboflavin drops and treated with ultraviolet light. Corneal crosslinking can help reduce the risk of progressive vision loss by stabilizing the cornea early in disease.

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Surgical treatment

In some special cases, surgery may be required. Several surgeries are available, depending on the location of the bulging cone and the severity of your condition.

Surgical options include:

  • corneal appendages

During this surgery, your doctor places small, clear, crescent-shaped plastic inserts (intracorneal ring segments) into the cornea to flatten the cone, support the shape of the cornea, and improve vision.

Corneal attachments can restore a more normal corneal shape, slow progression of keratoconus, and reduce the need for corneal transplants.

This surgery can also make contact lenses easier to fit and tolerate. The corneal inserts can then be removed, so the procedure can be considered a temporary measure.

  • corneal transplant

If you have corneal scarring or excessive thinning, you will likely need a corneal transplant ( keratoplasty ). Penetrating keratoplasty is a complete corneal transplant.

In this procedure, doctors remove a full-thickness portion of your central cornea and replace it with donor tissue. A corneal transplant for keratoconus is usually very successful, but possible complications include graft rejection, poor vision, astigmatism, inability to wear contact lenses, and infection.

Can keratoconus be prevented?

Most cases cannot be prevented, but you can reduce your risk of developing this eye disorder by:

  • Protecting your eyes from UV radiation with sunglasses
  • Making sure your contact lenses fit well
  • Getting treatment for any eye condition
  • not rubbing your eyes

Keratoconus complications

In rare cases, severe keratoconus causes a complication called corneal hydrops . This happens when part of your cornea is broken. This can cause an abnormal flow of fluid from your eye into the cornea, causing severe pain and swelling. Sudden vision loss may also occur.

If you have corneal hydrops, you may need to wear special contact lenses or use special eye drops. Usually this goes away within a few weeks.

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