Keratoconus: Causes, Symptoms, and Treatment

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title: "Keratoconus: Causes, Symptoms, and Treatment" description: "Learn about keratoconus, a progressive corneal condition that causes irregular corneal shape, and the modern treatment options available." date: "2024-01-15" author: "Dr. Christopher S. Sales, MD, MPH" image: "/images/blog/keratoconus.jpg" imageAlt: "Diagram showing normal cornea vs keratoconus cornea shape" tags:

• "keratoconus"
• "corneal disease"
• "crosslinking"
• "corneal transplant" category: "Conditions" featured: false draft: false

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Keratoconus is a progressive eye condition that causes the cornea to thin and bulge into a cone-like shape. This distorts vision and can significantly impact quality of life if left untreated. The good news: modern treatments can slow or halt progression and often restore functional vision.

What is Keratoconus?

The cornea—the clear, dome-shaped front of the eye—is normally round like a basketball. In keratoconus, the cornea gradually thins and bulges outward, becoming cone-shaped. This irregular shape causes:

• Distorted, blurry vision
• Increased nearsightedness
• Irregular astigmatism
• Light sensitivity
• Difficulty with glasses correction

Keratoconus typically begins in the teenage years or early 20s and may progress for 10-20 years before stabilizing.

What Causes Keratoconus?

The exact cause isn't fully understood, but factors include:

Genetic predisposition: About 10% of keratoconus patients have an affected family member.

Eye rubbing: Chronic, vigorous eye rubbing is strongly associated with keratoconus progression. If you have keratoconus or are at risk, stop rubbing your eyes.

Associated conditions: Higher rates in people with:

• Allergies (leading to eye rubbing)
• Down syndrome
• Connective tissue disorders
• Some retinal conditions

Recognizing the Symptoms

Early symptoms often mimic common vision problems:

• Frequent changes in glasses prescription
• Glasses not fully correcting vision
• Blurry or distorted vision
• Increased light sensitivity
• Glare, especially at night
• Headaches from eye strain

As the condition progresses:

• Multiple images or "ghosting"
• Significant astigmatism
• Unable to achieve clear vision with glasses
• Contact lens intolerance

How Keratoconus is Diagnosed

Diagnosis requires specialized testing:

Corneal topography: Maps the corneal surface and can detect early keratoconus before symptoms appear.

Corneal pachymetry: Measures corneal thickness—keratoconic corneas are typically thinner.

Slit-lamp examination: Allows direct visualization of corneal changes.

Regular screening is important for family members of keratoconus patients and anyone with risk factors.

Treatment Options

Treatment goals are twofold:

1. Stop progression (if still progressing)
2. Improve vision

Corneal Crosslinking (CXL)

For progressive keratoconus, crosslinking is the only treatment proven to halt progression:

• UV light and riboflavin (vitamin B2) strengthen corneal tissue
• Creates new bonds between collagen fibers
• Stops or slows further corneal weakening
• Outpatient procedure with good safety profile

Crosslinking is most effective when performed early—before significant corneal damage occurs. If keratoconus is detected and showing progression, timely crosslinking can prevent the need for transplant.

Vision Correction Options

Glasses: Work in early stages but often insufficient as the condition progresses.

Soft contact lenses: May help initially but usually insufficient for irregular astigmatism.

Specialty contact lenses: The mainstay of keratoconus vision correction:

• Rigid gas permeable (RGP) lenses
• Hybrid lenses
• Scleral lenses (increasingly popular—larger, more comfortable)
• Custom soft lenses

These lenses create a smooth optical surface over the irregular cornea.

Intracorneal ring segments: Plastic segments implanted in the cornea to flatten and regularize its shape.

Corneal Transplant

For advanced keratoconus when contact lenses no longer work:

DALK (Deep Anterior Lamellar Keratoplasty): Replaces most of the cornea but preserves the innermost layer—often preferred for keratoconus.

PK (Penetrating Keratoplasty): Full-thickness transplant, reserved for severe cases.

Modern crosslinking has dramatically reduced the number of keratoconus patients who need transplant.

Living with Keratoconus

Stop rubbing your eyes: This is critical and may slow progression.

Manage allergies: Reduces the urge to rub.

Protect your eyes: Wear sunglasses and safety glasses when appropriate.

Regular follow-up: Monitor for progression and catch changes early.

Specialty lens care: If you wear scleral or RGP lenses, proper care prevents complications.

The Importance of Early Detection

Keratoconus outcomes are best when detected and treated early:

• Crosslinking can halt progression before significant damage
• Less corneal distortion means better vision correction options
• May prevent the need for transplant altogether

If you have a family history of keratoconus, experience unexplained vision changes, or find that your glasses never quite work well, a comprehensive evaluation with corneal topography is worthwhile.

Expert Keratoconus Care

Dr. Sales specializes in corneal conditions including keratoconus, offering:

• Advanced diagnostic imaging
• Corneal crosslinking
• Corneal transplant when needed
• Coordination with specialty contact lens providers

Schedule a consultation if you're concerned about keratoconus or have been recently diagnosed.