Keratoconus

Definition
Keratoconus is a deterioration of the structure of the cornea with gradual bulging from the normal round shape to a cone shape. This condition causes decreased visual acuity. It is frequently discovered during adolescence.

Causes, incidence, and risk factors

The cause is unknown. Keratoconus is more common in contact lens wearers and people with nearsighted eyes. Some researchers believe that allergy may play a role.

Symptoms

The earliest symptom is subtle blurring of vision that is not correctable with glasses. (Vision is generally correctable to 20/20 with gas permeable contact lenses.)

Signs and tests

Keratoconus can usually be diagnosed with slit lamp examination of the cornea. Early cases may require corneal topography, a test that involves making a stereo image that gives a topographic map of the curvature of the cornea.

When keratoconus is advanced, the cornea may be thinner in areas. This can be measured with a painless test called pachymetry.

Treatment

Contact lenses are the primary treatment and are satisfactory treatment for most patients with keratoconus. Severe cases may require corneal transplantation.

Expectations (prognosis)

In most cases vision can be corrected with gas-permeable contact lenses. Where corneal transplantation is needed, results are usually good after a long recovery period.

Complications

Patients with keratoconus should not have laser vision correction. Corneal topography is usually done before laser vision correction to rule out people with this condition.

Calling your health care provider

Young persons whose vision cannot be corrected to 20/20 with glasses should be evaluated by an eye doctor experienced with keratoconus.

Prevention

There are no preventive measures. Some specialists believe that patients with keratoconus should have aggressive treatment of ocular allergy and should be instructed not to rub their eyes.

Johns Hopkins patient information

Last revised: December 4, 2012
by Harutyun Medina, M.D.

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