Keratoconus is a degenerative disease of the cornea that causes it to  gradually thin and bulge into a cone-like shape.  This shape prevents light from focusing precisely on the macula.  As the disease progresses, the cone becomes more pronounced, causing vision to become blurred and distorted.  Because of the cornea's irregular shape, patients with keratoconus are usually very nearsightedand have a high degree of astigmatism that is not correctable with glasses.Keratoconus is sometimes an inherited problem that usually occurs in both eyes.


Signs and Symptoms

  • Nearsightedness
  • Astigmatism
  • Blurred vision - even when wearing glasses and contact lenses
  • Glare at night
  • Light sensitivity
  • Frequent prescription changes in glasses and contact lenses
  • Eye rubbing

Detection and Diagnosis

keratoconusKeratoconus is usually diagnosed when patients reach their 20's. For some, it may advance over several decades, for others, the progression may reach a certain point and stop.

Keratoconus is not usually visible to the naked eye until the later stages of the disease. In severe cases, the cone shape is visible to an observer when the patient looks down while the upper lid is lifted. When looking down, the lower lid is no longer shaped like an arc, but bows outward around the pointed cornea. This is called Munson's sign.

Special corneal testing called topographyprovides the doctor with detail about the cornea's shape and is used to detect and monitor the progression of the disease. Apachymeter may also be used to measure the thickness of the cornea.


The first line of treatment for patients with keratoconus is to fit rigid gas permeable (RGP) contact lenses. Because this type of contact is not flexible, it creates a smooth, evenly shaped surface to see through. However, because of the cornea's irregular shape, these lenses can be very challenging to fit. This process often requires a great deal of time and patience. New advances in contact lenses inlcude the Synergeyes hybrid design which combine the comfort of soft lenses as well as the clarity of rigid lenses.

St. Lukes Eye. Keratoconus. 9 July 2009.

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