Keratoconus: Symptoms, Diagnosis & Treatment

Overview

The cornea is normally a smooth, evenly curved dome. In keratoconus, the corneal tissue progressively weakens and thins, causing it to bulge forward into an irregular cone shape. This distorts the way light is focused and results in blurred, distorted vision that spectacles increasingly struggle to correct.

Keratoconus most often begins during the teenage years or early adulthood and can progress over several years before typically stabilising, though the rate and degree of progression vary from person to person and between the two eyes.

Because keratoconus can progress silently in its early stages, especially in young patients with frequent spectacle power changes, timely corneal imaging is key to catching it before vision is significantly affected.

Symptoms

• Progressively blurred or distorted vision, not fully correctable with regular glasses
• Frequent changes in spectacle power, especially astigmatism
• Increased sensitivity to light and glare
• Difficulty with night vision
• Ghosting or streaking of lights
• Eye rubbing habit, which can worsen the condition

Causes

The exact cause of keratoconus is not fully understood, but it is believed to result from a combination of genetic predisposition and mechanical/biochemical factors that weaken the structural fibres of the cornea.

Risk Factors

• Family history of keratoconus
• Chronic and vigorous eye rubbing
• Allergic eye conditions causing persistent itching
• Certain connective tissue disorders
• Onset typically between the teenage years and early 30s

When to See a Doctor

See an ophthalmologist if a teenager or young adult has rapidly increasing spectacle power (particularly astigmatism), vision that is not fully corrected by glasses, or a strong habit of eye rubbing, as these are early warning signs of keratoconus.

A family history of keratoconus is a reason for proactive screening even without symptoms.

Diagnosis

Keratoconus is diagnosed through corneal shape mapping, which detects the characteristic irregular steepening pattern well before it may be obvious on routine examination.

Tests

• Slit lamp examination for corneal thinning and characteristic signs
• Corneal topography, available on a rental basis, to map the corneal surface and confirm diagnosis and stage
• Refraction to document the degree and pattern of astigmatism
• Serial monitoring with repeat topography to assess progression over time

Treatment Options

Treatment goals are to halt progression and to optimise vision, and often combine more than one approach.

• Corneal collagen cross-linking (CXL) — a procedure to strengthen corneal tissue and halt progression, most effective when done early
• Spectacles or soft contact lenses for mild keratoconus with regular astigmatism
• Specialty rigid or scleral contact lenses for more advanced, irregular corneas
• Advice against eye rubbing, and treatment of any underlying eye allergy contributing to it
• Referral for corneal transplantation in advanced cases where other measures cannot restore functional vision

Expected Outcomes

When detected early, keratoconus progression can usually be halted with cross-linking, preserving useful vision often with the help of contact lenses. Outcomes are less predictable in advanced or rapidly progressing disease, which is why early diagnosis and consistent follow-up make the biggest difference.

Why Choose Dr. Murkute's O2 Bone & Eye Care

• Careful clinical evaluation and corneal topography by Dr. Dipti Murkute (Pansare), MBBS, DNB Ophthalmology, FICO (UK)
• Early detection focus for teenagers and young adults with changing spectacle power
• Clear explanation of cross-linking and contact lens options suited to the stage of disease
• Structured long-term monitoring with serial topography
• Convenient Kharadi location for patients across East Pune