Keratoconus is a common corneal disorder where the central or paracentral cornea undergoes progressive thinning and steepening causing irregular astigmatism.
Eye rubbing, associated with atopy
Floppy Lid Syndrome
General treatment: The goals of treatment are to provide functional visual acuity and to halt changes in the corneal shape.
For visual improvement and astigmatism management, spectacles or soft toric contact lenses in mild cases can be used. Rigid gas permeable contact lenses are needed in the majority of cases to neutralize the irregular corneal astigmatism. The majority of patients that can wear hard or gas-permeable contact lenses have a dramatic improvement in their vision. Specialty contact lenses have been developed to better fit the irregular and steep corneas found in keratoconus; these include ( but not limited to) RoseK, cutom designed contact lenses ( based on topography and/or wavefront measurements), semi-scleral contant lenses, piggy back lens use ( soft and hard lens used at the same time), and scleral lenses. Those patients that become contact lens intolerant or do not have acceptable vision, typically from central scaring, can proceed to surgical alternatives.
The primary treatment for progressive keratoconus, or keratoconus in young patients likely to progress at some point, is corneal collagen cross linking. This treatment, approved by the FDA in the Spring of 2016 and CE marked 10 years earlier throughout Europe in 2006, uses riboflavin and UV light to induce hardening of the otherwise weak and flacid keratoconic cornea. Traditional corneal collagen cross linking involves a minimally invasive treatment through removal of the corneal epithelium followed by soaking of the cornea in riboflavin drops and a slow exposure of the cornea to UV light. Variations of this conventional “epithelium-off” technique involve higher intensities of UV for shorter time periods (accelerated cross linking) or non-removal of the epithelium (“epithelium-on”) techniques. The FDA trial and most European data sets demonstrate the high success rate for the conventional epithelium-off cross linking approach. Other approaches have shown some promise and success, but overall have been less consistent and reliable in their abilities to halt keratoconus.
Medical therapy for patients who have an episode of corneal hydrops involves acute management of the pain and swelling. Patients are usually given a cycloplegic agent, sodium chloride (Muro) 5% ointment and may be offered a pressure patch. After the pressure patch is removed patients may still need to continue sodium chloride drops or ointment for several weeks to months until the episode of hydrops has resolved. Patients are advised to avoid vigorous eye rubbing or trauma.
Patients are usually followed on a 3 to 6-month basis to monitor the progression of the corneal thinning, steepening, the resultant visual changes, and to re-evaluate the need for cross linking and patient contact lens fit and care. Patients with hydrops are seen more frequently until it resolves.
If you have keratoconus, please schedule a consultation with us to determine the appropriate treatment plan for your particular eyes.