Keratoconus

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Introduction:

  • An increase in curvature of cornea
  • Cause: Thinning and protrusion of cornea
  • Seen in young adults.

Symptoms:

  1. Frequent change of glasses
  2. Painless progressive loss of vision
  3. Uniocular diplopia (due to astigmatism).

Signs (Mnemonic: FAMOUS):

  •  F: Fleischer ring (Fe deposition in epithelium in the base of cornea)
  • A: Astigmatism (irregular)
  • M: Munson sign: Bulging of lower eyelid
  • O: Oil droplet reflex
  • U (V): Vogt’s sign (thin cornea)
  • S: Scarring of cornea.

Special signs:

Rizzuti sign: Light shone from temporal side results in an arrowhead like appearance of light on the nasal side.

Scissoring reflex on retinoscopy:

Due to irregular astigmatism.

 

Oil in Ophthalmology:

  1. Oil droplet reflex: Keratoconus
  2. Oil globule reflex: Anterior lenticonus
  3. Oil droplet cataract: Galactosemia.

 

Acute hydrops:

  • Descemet membrane rupture
  • Aqueous goes into the layers of cornea, leading to opacification
  • ONLY condition in keratoconus where pain occurs
  • Rx: Full thickness (penetrating) keratoplasty.

Investigations of keratoconus:

  1. Orbscan (IOC)
  2. Keratometry (Corneal curvature)
  3. Pachymetry (Corneal thickness).

 

Treatment of keratoconus:

  • Contact lens is the first treatment for keratoconus patients
  • Rigid gas permeable (RGP): Contact lens of choice
  • For progressive keratoconus in spite of wearing contact lens, C3R (Corneal Collagen Cross-Linking with Riboflavin) is done.

 

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