UNDERSTANDING KERATOCONUS

Keratoconus is a multifactorial disease with genetic, biochemical, biomechanical, and

environmental pathophysiology .
It is a degenerative non inflammatory disease of the cornea. The central or paracentral
cornea undergoes progressive thinning and steepening causing myopia and both
regular and irregular astigmatism

• Keratoconus • Early/subclinical keratoconus

- Clinical slit-lamp signs of keratoconus - No slit lamp findings
- Scissoring on retinoscopy - Scissoring of reflex of the retinoscopy
- Keratoconus topography pattern - Keratoconus topography pattern

• Keratoconus-suspect
- No clinical signs, no scissoring
- Keratoconus topography pattern
2
 Epithelium

Bowman’s Layer

Stroma

Descemet’s
membrane

Endothelium
PATHOLOGICAL FEATURES OF KERATOCONUS

1. Corneal Thinning

2. Oxidative Damage

3. Anterior Corneal Instability

CORNEAL THINNING
CORNEAL THINNING
BIOMECHANICAL
 ENVIRONMENTAL
Keratoconus cells are overly sensitive to stressors

– Poorly fit contact lenses

– Vigorous eye rubbing

– UV light

– Allergies

Can not process the ROS produced by these stressors as efficiently

as normal corneal cells
OXIDATIVE STRESS
 SYMPTOMS
IN EARLY STAGE
•mild blurring of vision
•slightly distorted vision,
where straight lines look
bent or wavy
•increased sensitivity to li
ght
 and glare
•eye redness or swelling
LATER STAGE
•more blurry and distorted vision
•increased nearsightedness or 
astigmatism (when your eye cannot
focus as well as it should). As a
result, you may need new eyeglass
prescriptions often.
•not being able to wear 
contact lenses. They may no
longer fit properly and they are
uncomfortable.
SIGNS
SIGNS
Vog’t striae

Fleischer ring

Corneal apical scarring

Prominent corneal nerve

Hydrops
KERATOCONUS TOPOGRAPHY
ASTIGMAT AGAINTS THE ROLE
ABNORMAL TOPOGRAPHY
ASTIGMAT WITH THE ROLE

NORMAL TOPOGRAPHY
 TREATMENT

Intacts help flatten the curvature of your cornea to

improve vision

• Collagen cross-linking  helps to flatten or stiffen your

cornea, keeping it from bulging further.

Corneal transplant  When symptoms are severe

• Specialized Contact Lenses  RGP, Scleral Lens, Prose Lens

Intracorneal Ring Segments  Intracorneal ring segments are

plastic, C-shaped rings that are used to flatten the surface of
the cornea
 Specialized Contact Lenses

• Rigid Gas Permeable Contact Lenses

• Scleral Lenses
• PROSE Lenses.