Keratoconus caused by eye rubbing in patients with Tourette Syndrome

Mashor, Raneen Shehadeh; Kumar, Naresh; Ritenour, Rusty; Rootman, David S.

doi:10.3129/i10-072

Cited by 70 publications

(27 citation statements)

References 24 publications

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“…8 In the present case, the child had severe atopy but few visual symptoms other than ocular itchiness. The importance of avoiding eye rubbing, a risk factor for the development 12,13 and progression 10 of keratoconus, had not been discussed. Such factors led to a delayed diagnosis of keratoconus and potential disease progression due to unidentified environmental risk factors.…”

Section: Discussionmentioning

confidence: 99%

The Necessity for Ocular Assessment in Atopic Children: Bilateral Corneal Hydrops in an 8 Year Old

Downie

2014

Pediatrics

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Acute corneal hydrops is a rare complication of advanced corneal ectasia. This case report describes the clinical course of a child with severe atopy and no previous ocular examination who developed bilateral, acute corneal hydrops, secondary to keratoconus, by 8 years of age. The report demonstrates the rapidity of progression in the pediatric phenotype of the disease. This case also provides an important clinical lesson in highlighting the necessity for children with atopy to be referred for comprehensive ophthalmic examination, even in the apparent absence of visual symptoms, to ensure the timely diagnosis and management of any atopy-associated ocular disease. Prompt referral is particularly essential for pediatric corneal ectasia, in which the rapidity of progression may preclude stabilizing treatments, such as corneal collagen cross-linking, and result in significant childhood visual impairment, as was the case for this child. This case demonstrates the potential for significant ocular involvement in atopic children and identifies scope to enhance current international clinical guidelines relating to the management of childhood atopy through the inclusion of ocular screening for associated disease.

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Section: Discussionmentioning

confidence: 99%

The Necessity for Ocular Assessment in Atopic Children: Bilateral Corneal Hydrops in an 8 Year Old

Downie

2014

Pediatrics

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“…[12] Rabinowitz has also reported higher rate of eye rubbing in KCN patients than normal ones (80% vs. 58%; P < 0.001). [13] Although none of these studies confirm a cause and effect relationship between eye rubbing and KCN, the many reports with unilateral KCN [91014] or more severe corneal steepening [71516] in cases of unilateral eye rubbing lead us to conclude a strong predisposing role for eye rubbing in development or progression of KCN.…”

Section: Discussionmentioning

confidence: 93%

“…In a multivariate analysis of potential risk factors of KCN, only eye rubbing was a significant predictor of KCN development,[2] which is one of the potential causes of recurrent KCN in transplanted corneas as well. [34] The majority of KCN cases have been reported to be related to vigorous eye rubbing due to various causes such as atopy,[5] Tourette syndrome,[67] Down syndrome [8] or the necessity for eye wiping in nasolacrimal duct obstruction [9] and punctual agenesis. [10] Herein, we report a case of acquired unilateral KCN in a middle-aged lady secondary to a forceful persistent globe massage after trabeculectomy.…”

Section: Introductionmentioning

confidence: 99%

Post filtering surgery globe massage-induced keratoconus in an eye with iridocorneal endothelial syndrome: A case report and literature brief review

Fakhraie¹,

Vahedian²

2016

J Ophthalmic Vis Res

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Purpose:To report a case of unilateral post trabeculectomy globe massage-induced keratoconus (KCN).Case Report:A 52-year-old lady with a history of trabeculectomy due to iridocorneal endothelial syndrome in her right eye was instructed to massage her globe to control gradual rise of intraocular pressure 1.5 years after surgery. The patient experienced high astigmatism and marked inferior corneal steepening after 3 years of globe massage. The left eye was normal in all aspects. Findings in different visual examinations were compatible with the diagnosis of unilateral KCN in the right eye of our patient.Conclusion:Chronic forceful frequent eye rubbing particularly with fingertips can be assumed to be the most important causative factor for KCN formation in this patient.

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“…In this report which primarily investigates visual field defects in a group of 12 patients with TS, it is noted that two patients exhibited keratoconus, with no further analysis concerning the aetiologic relationship between the two conditions. Furthermore, Mashor et al recently described three cases of patients with TS-provoked eye rubbing that exhibited keratoconus [7]. …”

Section: Case Presentationmentioning

confidence: 99%

A case of bilateral self-induced keratoconus in a patient with tourette syndrome associated with compulsive eye rubbing: case report

et al. 2011

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BackgroundTourette syndrome is a neurologic disorder that is characterized by repetitive muscle contractions that produce stereotyped movements or sounds. Approximately 50% of individuals with TS also exhibit obsessive-compulsive behaviors including eye rubbing. We report a case of bilateral self-induced keratoconus in a patient with TS, associated with compulsive eye rubbing.Case presentationA 35-year-old man was first seen in our clinic as an outpatient due to rapid deterioration of vision in his right eye associated with pain and tearing, over a period of one month. Slit lamp biomicroscopy of the right eye showed a central stromal scar due to corneal hydrops. Clinical examination and corneal topography of the left eye were normal. Six months later the patient developed corneal hydrops of his left eye. During the following examinations his vision continued to deteriorate in both eyes, while a central stromal scar was forming in his left cornea. Four years after the initial examination the patient's visual acuity was no light perception in the right eye and counting fingers at 33 cm in the left eye. His right eye was phthisic.ConclusionsOur patient developed a rapidly progressing bilateral corneal ectasia and phthisis of his right eye during a time period of 4 years. This unusual pattern suggests that the patient's compulsive behavior compromised both of his corneas and led to bilateral keratoconus.

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Keratoconus caused by eye rubbing in patients with Tourette Syndrome

Cited by 70 publications

References 24 publications

The Necessity for Ocular Assessment in Atopic Children: Bilateral Corneal Hydrops in an 8 Year Old

The Necessity for Ocular Assessment in Atopic Children: Bilateral Corneal Hydrops in an 8 Year Old

Post filtering surgery globe massage-induced keratoconus in an eye with iridocorneal endothelial syndrome: A case report and literature brief review

A case of bilateral self-induced keratoconus in a patient with tourette syndrome associated with compulsive eye rubbing: case report

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