Keratoconus (KC) is an eye condition that causes imperfect vision in the people affected by it.

It often causes thinning of the cornea and gradually bulging outward into a cone shape.

According to Johns Hopkins Medicine, nearly one in two thousand people is affected by this condition.

Generally, this condition starts in the late teens and may take 10 to 20 years to progress.

Eventually, it degrades vision quality and increases dependency on technological-aided treatment measures.

Early recognition of the condition and its treatment is helpful in preventing its progression.

This comprehensive article will deeply explain Keratoconus, its symptoms, diagnosis, and treatment to help you learn more about this eye condition.

Read the complete article and get insight into how this eye condition may affect you and your lifestyle.

What is Keratoconus

Keratoconus is a condition that affects the cornea, an outermost dome-shaped part of the eye.

It causes thinning and eventually bulging out of the cornea in a cone-shaped structure.

This change in its curvature or shape causes blurred vision and other eyesight-related problems, such as Astigmatism.

KC is a non-inflammatory, progressive, bilateral, and primary Ectatic Corneal Disease (ECD).

ECD is a group of progressive eye conditions that affects the cornea and can result in mild to severe vision impairment.

Keratoconus stages

There are four stages of Keratoconus. The condition gets progressively dangerous and may lead to distorted and unclear vision.

The stages are:

Early stage

Early Keratoconus condition has less distortion with no progression.

It may negligibly or not affect the quality of the image.

You can use spectacles or soft contact lenses for treating early stages, as they may give adequate vision.

Moderate stage

In this stage, corneal distortion increases, and vision quality changes.

It can be treated with rigid gas-permeable contact lenses covering and neutralizing distortion.

The gas permeability allows gases, i.e., oxygen, to pass through the lens material.

Advanced stage

The corneal condition changes from slightly distorted to moderately distorted. 

You can use scleral rigid gas permeable contact lenses to improve comfort and stability.

So though these contact len cover the entire cornea, plenty of oxygen reaches the front of the eye, ensuring healthy and comfortable eyes.

Severe stage

In this stage, the cornea faces extreme distortion, scarring, and thinning in its structure. 

This condition is often marked by poor vision due to reduced contact lens tolerance and difficulty in fitting the lens.

Warning:
To prevent the severe stage of Keratoconus, visit your doctor as soon as possible to treat corneal distortion, or the condition may worsen over time.

Early symptoms of Keratoconus

In the early stages of KC, people may not notice any symptoms. 

However, the symptoms may appear in the later stages of the condition.

People may start seeing their KC symptoms in the late teen years.

These symptoms gradually progress until 10 to 20 years and may worsen the vision.

Generally, the early signs of the condition may appear in one eye. But in most cases, it affects both eyes.

Consequently, people may have two different visions between two eyes.

Therefore, symptoms in one eye may differ from the other eye and can change over time.

Some of the symptoms of Keratoconus include:

Distorted vision

distorted and blurred vision
Blurred vision

The scarring of the cornea loses its smoothness and becomes unclear. 

It results in distorted and blurred vision.

A distorted image occurs when objects or straight lines look wavy or bent incorrectly.

Increased sensitivity to light

Sensitivity to light is another symptom that affects your daily life.

Long exposure to computer screens may increase light sensitivity in people.

People may find it difficult to drive at night because of the distortion in vision.

Astigmatism

The cornea’s thinning and protrusion (bulging out) cause corneal distortion and result in irregular Astigmatism.

Astigmatism occurs when the curvature of the cornea or lens is irregular. 

It results in periodic bending of light on the cornea causing blurry image formation.

In Keratoconus, the conical cornea bulges outwards.

Hence, people with KC also have Astigmatism symptoms.

However, it is important to note that people with KC have Astigmatism, but not all Astigmatism in people lead to KC.

Myopia

KC also shows signs of Myopia.

Myopia is an eye defect where people have nearsightedness, and they have difficulty seeing far objects.

Therefore, children with KC may struggle to see whiteboards and screen projections in the classroom. 

According to ScienceDirect, as this eye condition increases, it results in more irregularity in patients having Myopia and Astigmatism.

Fleischer iron rings

Initially, Fleischer rings do not cause any symptoms. However, as KC progresses, it can be seen with the naked eye.

Fleischer rings are formed due to the deposition of rust-colored iron.

These are partial or complete rings in the deep epithelium encircling the cone of KC.

Red eyes and irritation

People may notice red eyes as an early sign of KC.

They may also feel sudden eye irritation and the urge to rub them.

Acute Corneal Hydrops (ACH)

Acute Corneal Hydrops is also associated with Keratoconus.

ACH occurs due to aqueous (fluid in the eyes) leakage by tearing an eye membrane. 

It causes sudden blurry vision and pain in the eyes.

Causes of Keratoconus

The definitive causes of this eye condition are unknown.

However, many believe that it is caused due to hereditary reasons or it may be caused due to loss of Collagen in the cornea.

Moreover, according to Hopkins Medicines, consistent inflammation due to allergies or irritants may elevate the risks of developing KC due to corneal damage. 

Risk factors of Keratoconus

The risk factors of KC comprise environmental and genetic factors.

Moreover, according to NCBI, environmental factors might be essential in triggering the condition in genetically predisposed individuals.

Environmental factors

These are the following environmental risks that may elevate the risks of Keratoconus in people:

UV lights

UV rays are the active source of Reactive Oxygen Species (ROS), and exposure may cause oxidative stress in the KC cornea.

It also reduces the enzymes necessary to remove Reactive Oxygen Species and worsens the condition.

Therefore, KC’s prevalence is higher in hot countries than in cold countries.

Rubbing eyes

higher risk of KC in patients who rub their eyes
Rubbing eyes

Many researchers associate a higher risk of KC in patients who rub their eyes.

The usual length of rubbing eyes in KC patients is much higher than in allergic patients.

However, it is still a topic of discussion, as there are many cases of KC in patients having no history of eye rubbing.

Also, researchers believe there can be a mechanical reason behind this, such as poorly fitted rigid contact lenses.

Atopy

Atopy is a hypersensitivity reaction that includes allergies and Asthma.

There are conflicting reports between KC and Atopy. However, some researchers believe in this association.

Allergy caused due to animal fur, pollens, and dust particles may be associated with the onset of KC.

Geographical factors

Compared to cold countries, Keratoconus is prevalent in countries with hot and sunny climates.

This geographical disparity is caused due to exposure of UV sunlight in the regions.

Genetic factors

Having a family history of Kerataconus may elevate the risks of the condition in you.

Family history is present in 10-20% of Keratoconus patients.

However, whether familial genetics causes KC is still under research. But many researchers believe in this relation.

Moreover, patients with other conditions, such as Down’s Syndrome, are at a higher risk of developing KC.

Diagnosis of Keratoconus

A doctor may diagnose Keratoconus by following the techniques mentioned below:

Slit-lamp examination

Examining the patient at a slit-lamp can help diagnose several Keratoconus features.

In KC, the cornea thins at the central and paracentral parts, and rings form at the base of the cornea.

The examination can clearly show the iron-deposited Fleicher rings and confirm Keratoconus in the person.

Corneal topography and tomography

It provides the necessary information about the cornea and its curvature.

The corneal topographic map will show the signs of irregular Astigmatism.

It can also detect and show additional anterior and posterior corneal curvature.

Usually, KC exhibits periodic changes and thinning in its curvature.

The topography map can clearly show the difference in corneal thickness and hence detects the condition before other clinical or biomicroscopic signs can be identified.

Treatments for Keratoconus

Keratoconus is a chronic eye disorder, and currently, there is no permanent cure for the condition.

However, crucial research is taking place to find a permanent solution to KC.

Fortunately, The Eye Defect Research Foundation has successfully identified the genes behind the condition.

They hope to provide effective treatment through gene therapy and stem cell therapy.

However, there are effective treatment methods to improve vision with eye management and vision technology.

Some effective techniques to treat Keratoconus are:

Self-care treatment without surgery

The effective self-care measures to treat Keratoconus are:

Wear 100% ultraviolet protection sunglasses

Wear 100% ultraviolet protection sunglasses
Wear UV protected sunglasses

Exposure to unprotected UV rays (sunlight) may worsen your eye condition. 

It is advised to wear 100% UV-blocking sunglasses to prevent harmful rays from affecting your eyes.

You can consult your doctor to prescribe sunglasses if you wear corrective glasses.

Avoid rubbing your eyes

Constant rubbing of your eyes can damage the cornea and is a common way of developing KC.

Thus, it is recommended to avoid rubbing your eyes as chronic eye rubbing may accidentally damage corneal tissue.

You can wash your eyes to relieve any irritation in the eyes.

Moisten your dry eyes with artificial tears

Artificial tears may relieve irritation in your dry eyes

You can consult your doctor to prescribe them, as consistent dry eyes may worsen KC.

According to a 2015 study, Cyclosporin A may reduce the progression of the disease. 

Therefore, it can be a novel treatment for KC. However, it needs more research.

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You can protect your eyes by purchasing Imudrops Singules and prevent dry eyes. 

Anti-histamines to avoid allergies

Allergies may cause eye inflammation, and you can accidentally rub them.

To avoid this, you can use anti-histamine medications and prevent allergens such as pollens.

On facing serious inflammation, you can consult your doctor to avoid complications.

Include an antioxidant-rich diet to protect the cornea

Antioxidant rich diet is effective in reducing oxidative stress caused due to free radicals in the body.

It inhibits the disturbances in the body’s metabolism and ensures proper functioning.

Otherwise, it may lead to the worst scenario for KC.

Therefore, you should eat plenty of antioxidants, such as leafy vegetables, soy, beans, etc. 

Devices

The devices that may be helpful in treating Keratoconus are:

Corrective and contact lenses

doctors recommend corrective lenses and spectacles
Contact lenses

In the early stages of KC, doctors recommend corrective lenses and spectacles.

It may become a long-term treatment if your cornea stabilizes with time.

Soft contact lenses can be suitable for mild KC.

However, a gas-permeable (allows gases to pass through them) rigid contact lens is recommended in advanced stages.

Corneal implant (intacs)

These are favored when your KC has progressed and caused high Astigmations. It makes your vision blurry and prevents wearing contacts.

Intacs are crescent-shaped, tiny plastic implants placed into your cornea.

It can improve vision by flattening the curvature of the cornea. 

The FDA approves intacs, and in patients, it can reduce nearsightedness and Astigmatism in KC.

It is an effective device and may delay or even avoid the risk of corneal transplantation.

Surgery

Surgeries are an effective treatment for people in the advanced stage of Keratoconus. The following surgeries to treat KC:

Corneal transplantation

The ophthalmologists recommend a cornea transplant depending on the severity of your eye condition.

The doctor surgically removes and transplants the diseased part of your cornea with the donor’s cornea. 

This procedure, or operation, is also known as Keratoplasty.

Overall, it helps restore vision and reduce pain in the case of KC.

Fact:
Corneal transplant is a safe and effective approach to restore vision in patients having corn