Eye Rubbing and Keratoconus: A Literature Review

Hawkes, Elizabeth; Nanavaty, Mayank A.

doi:10.5005/jp-journals-10025-1090

Cited by 23 publications

(21 citation statements)

References 59 publications

(45 reference statements)

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“…Several biochemical and biomechanical processes link eye rubbing to structural corneal changes and ectatic corneal disorders like keratoconus, keratoglobus and pellucid marginal degeneration, [ 1 , 2 ] especially in patients suffering from dry eyes or atopy [ 3 – 5 ]. Eye rubbing has been reported to alter the surface regularity prior to topography and this was thought to be due to changes in tear film and/or corneal remodelling [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

A randomized, fellow eye, comparison of keratometry, aberrometry, tear film, axial length and the anterior chamber depth after eye rubbing in non-keratoconic eyes

et al. 2017

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BackgroundTo investigate the effect of eye rubbing on keratometry (K), aberrometry, tear film break-up-time (TFBUT) and anterior chamber depth (ACD).MethodsVolunteers without any corneal pathology or dry eyes were randomised to rubbing in one eye and the fellow-eye was control. Eye rubbing was performed for 2 min. Primary outcomes studied were anterior and posterior K changes. Secondary outcomes were changes in TFBUT, axial length (AL) & ACD, K changes in various zones, asphericity and aberrometry. Pre and post rubbing K, aberrometry, ACD and TFBUT were assessed in a predetermined sequence. The relationship of the above parameters to axial length (AL) was also assessed. Astigmatism was analysed using vector analysis.ResultsPre versus post rubbing, anterior flatter K further flattened (42.51 ± 1.52 D vs. 42.36 ± 1.53 D, p = 0.003) and the changes to J0 vector in central cornea (−0.16 ± 0.26 D vs. -0.27 ± 0.33 D, p = 0.038) suggested change to against-the-rule (ATR) astigmatism. There was significant change in Z2 +2 polynomial following rubbing. We found a positive correlation between axial length and change in posterior K (r = 0.335, p = 0.020). The TFBUT reduced following eye rubbing (15.3 s vs. 13.9 s, p = 0.0001). There was a positive correlation between AL and increase in ACD post rubbing (r = 0.300, p = 0.038). There was a positive correlation between ACD and change in mean posterior K (r = 0.305, p = 0.035).ConclusionsIn healthy eyes, following eye rubbing, there is a significant change in TFBUT and central anterior K changes towards ATR astigmatism. Longer eyes had more changes in posterior K and ACD. Whereas, eyes with deeper ACD showed more steepness of posterior K.Trial registrationClinicalTrials.gov ID: NCT02131740.Electronic supplementary materialThe online version of this article (doi:10.1186/s40662-017-0084-8) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

A randomized, fellow eye, comparison of keratometry, aberrometry, tear film, axial length and the anterior chamber depth after eye rubbing in non-keratoconic eyes

et al. 2017

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“…19 The two-hit hypothesis is accepted as there is a combination of environmental factors, such as eye rubbing and atopy, and genetic predisposition. 8,9 In these presented cases, the genetics for both patients are the same. However, clinical keratoconus occurred only in one eye, which the patient referred to have rubbed more aggressively over her entire lifetime.…”

Section: Discussionmentioning

confidence: 78%

“…6,7 The twohit hypothesis refers to an underlying genetic-related susceptibility coupled with external environmental factors, including eye rubbing and atopy. 8,9 This study involved two identical twins; clinical keratoconus was detected in only one of the four eyes. The tomographic findings and clinical history of eye rubbing and ocular allergy illustrate the importance of going beyond of front surface topography to detect subclinical or very mild ectasia, as well as considering the environmental factors for ectasia development.…”

Section: Introductionmentioning

confidence: 99%

Subclinical Keratoconus Detection in Identical Twins

Ramos¹,

Guerra²,

Oliveira³

et al. 2016

International Journal of Keratoconus and Ectatic Corneal Diseases

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Purpose: To report clinical keratoconus in only one eye of two identical female twins, along with subclinical disease in the fellow eyes, elaborating on the two-hit hypothesis of ectasia development, which relates to the combination of genetics and the impact of environment.Methods: Case report and literature review.Results: Two identical 48-year-old female twins were presented for clinical evaluation. Mild keratoconus was detected in the right eye of twin 1, characterized by classic slit-lamp findings (exacerbated corneal nerves and incomplete Fleisher's ring) and front surface curvature abnormalities, including asymmetry of the inferior-superior curvature at 6 mm (I-S value) of 2.78 D and a grade 1 Topographic Keratoconus Classification pattern. Topographic Keratoconus Classification was possible in the fellow eye of twin 1 (I-S value = 1.22 D) and negative in both eyes of twin 2 (I-S value = -0.46 OD and -0.13 OS). Ambrósio's Relational Thickness for the maximal progression meridian was 209 and 354 in twin 1 and 360 and 392 in twin 2 in the right and left eyes respectively. The final deviation value of the Belin-Ambrósio Enhanced Ectasia Display was 4.54 and 1.47 in twin 1 and 1.7 and 1.35 in twin 2. Conclusion:Corneal tomography data provide a better representation of corneal genotype in detecting mild, subclinical, or forme fruste keratoconus in the fellow eyes with normal topography of these twins. These cases present high risk or susceptibility for ectasia progression if environmental factors are associated (second hit).

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“…According to experimental and clinical published studies, patients with KC have a genetic predisposition to corneal ectasia (first hit); however, ectasia might not be activated or reactivated unless an additional stressful event (second hit) triggers the disease (“two-hit” hypothesis). Triggering factors are sources of reactive oxidative stress; among them, mechanical trauma (vigorous eye rubbing, poorly fit contact lenses), exposure to ultraviolet light, and atopy/allergies [1, 7, 8].…”

Section: Discussionmentioning

confidence: 99%

Corneal ectasia following cataract extraction surgery in a patient with keratoconus: a case report

Labiris¹,

Panagiotopoulou²,

Ntonti³

et al. 2019

J Med Case Reports

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BackgroundAccording to experimental and clinical published studies, patients with keratoconus have a genetic predisposition to corneal ectasia; however, ectasia might not be activated or reactivated unless an additional stressful event triggers the disease. Triggering factors are sources of reactive oxidative stress; among them, mechanical trauma (vigorous eye rubbing, poorly fit contact lenses), exposure to ultraviolet light, and atopy/allergies. The aim of this case report is to present for the first time a case of rapidly progressive corneal ectasia in a patient with keratoconus following uncomplicated phacoemulsification surgery for cataract removal.Case presentationA 38-year-old Caucasian man was referred to our out-patient’s service due to bilateral cataract. He also had bilateral keratoconus and had undergone corneal cross-linking in both his eyes 5 years prior to his referral. Ever since the corneal cross-linking, keratoconus had been stable. He underwent a full ophthalmological examination including slit-lamp biomicroscopy, optical biometry, Scheimpflug tomography, corneal biomechanical assessment, and fundus examination. He presented advanced centrally located cataract with count fingers for preoperative best-corrected visual acuity. An uncomplicated cataract extraction surgery was performed. Preoperative flat keratometry reading was 40.5 diopters, steep keratometry reading was 41.8 diopters, astigmatism was 1.3 diopters, corneal hysteresis was 8.2, corneal resistance factor was 7.5, and thinnest corneal thickness was 503 μm. Within 3 months, he demonstrated rapidly progressing corneal ectasia in his operated eye, while 6 months postoperatively, flat keratometry reading was 45.5 diopters, steep keratometry reading was 48.3 diopters, astigmatism was 2.8 diopters, corneal hysteresis = 6.8, corneal resistance factor = 7.5, and thinnest corneal thickness = 318 μm.ConclusionsTo the best of our knowledge, this is the first report to describe corneal ectasia in a patient with keratoconus following phacoemulsification surgery. Cataract surgeons should provide extra caution to patients with keratoconus and take into consideration this rare but potentially sight-threatening complication.

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Eye Rubbing and Keratoconus: A Literature Review

Cited by 23 publications

References 59 publications

A randomized, fellow eye, comparison of keratometry, aberrometry, tear film, axial length and the anterior chamber depth after eye rubbing in non-keratoconic eyes

A randomized, fellow eye, comparison of keratometry, aberrometry, tear film, axial length and the anterior chamber depth after eye rubbing in non-keratoconic eyes

Subclinical Keratoconus Detection in Identical Twins

Corneal ectasia following cataract extraction surgery in a patient with keratoconus: a case report

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