Keratoconus is a vision disorder that occurs when the normally round cornea (the front part of the eye) becomes thin and irregular (cone) shaped. This abnormal shape prevents the light entering the eye from being focused correctly on the retina and causes distortion of vision. It is characterized by para-central corneal thinning and ectasia so that the cornea takes the shape of a cone. Visual loss occurs primarily from myopia and irregular astigmatism and secondarily from corneal scarring. Keratoconus often begins at puberty and most often is seen in teenagers or young adults.
Keratoconus causes distorted vision that cannot be corrected with eyeglasses. Tiny fibers of protein in your eye called collagen help hold your cornea in place. When these fibers get weak, they can’t hold their shape. Your cornea gets more and more cone-like.
It happens when you don’t have enough protective antioxidants in your cornea. Its cells produce harmful byproducts, the same way a car puts out exhaust. Normally, antioxidants get rid of them and protect the collagen fibers. But if levels are low, the collagen weakens and the cornea bulges.
Symptoms
Signs and symptoms of keratoconus may change as the disease progresses. They include:
Risk factors
Keratoconus is categorised clinically as:
Latent stage: Latent stage was recognisable by placido disc only.
Early stage: Early stages were subdivided into two categories as:
Causes
A family history of keratoconus has been established in some cases. Most researchers believe that multiple, complex factors are required for the development of keratoconus including both genetic and environmental factors.
With the advent of videokeratography to assess family members, however, pedigrees have been analysed. These studies show corneal changes consistent with keratoconus in some family members, which suggest an autosomal dominant pattern of inheritance.
Keratoconus may be associated with wide variety of systemic and ocular conditions.
Systemic associations:
Ocular associations:
Contributory factors such as:
Pathophysiology:
First is thinning of the corneal stroma then fragmentation of the Bowman layer and the deposition of iron in the basal epithelial cells, forming the Fleischer ring. Folds and breaks in the Descemet’s membrane result in acute hydrops and striae, which produces variable amount of diffuse scarring.
How diagnosis is made?
Certain tests like refraction, keratometry, corneal topography/Computerised videokeratography, ultrasound pachymetry and slit lamp microscopy help in reaching final conclusion.
Computerized videokeratography, which takes pictures of your cornea so a map can be made of the surface while also measuring the thickness of your cornea
Severity of keratoconus depends on shape of cone:
Treatment
If your keratoconus is progressing, corneal collagen cross-linking might be indicated to slow or stop the progression. Contact lenses can be used to correct astigmatism and mild near-sightedness. Improving your vision depends on the severity of keratoconus. Mild to moderate keratoconus can be treated with eyeglasses or contact lenses.
Lenses
Surgical Interventions
Some form of surgery may become necessary if the cornea progresses in its shape-changing until it is so steep that contacts cannot be tolerated at all.
Important Reminder: This information is only intended to provide guidance, not a definitive medical advice. Please consult eye doctor about your specific condition. Only a trained, experienced board certified eye doctor can determine an accurate diagnosis and proper treatment.
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