SUMMARY The association of keratoconus and atopic disease has been reported on several occasions but the only controlled clinical study that has so far been published found no evidence to support this view. Since it is now known that atopy is often associated with changes in various immunoglobulins, particularly IgE, it was considered desirable to determine the immunological profiles of a large series of keratoconus cases in order to seek evidence for coexistence of the two conditions in one individual. In this study of 182 cases of keratoconus a definite history of atopy was found in 35% compared with 12% in the matched control group. The serum IgE was significantly raised (P <0001) in keratoconus and markedly so in those cases with associated atopic disease. Serum levels of IgG and IgM were also raised, but contrary to the findings of other observers IgA levels were normal. These findings suggest that atopic traits are more common in patients with keratoconus than in general ophthalmic patients.

Patients were allowed to wear the lenses for the maximum tolerable times daily; care and disinfection of the lenses were as advised by the manufacturers. ResultsThe computer results were based on a data analysis collected over one year and the significance of the results determined by x2 fraction P < oo05. The details are shown in Tables I to VI. Of the 151 patients 76 had had previous experience with hard lenses and five of that group wore hard lenses successfully with good daily tolerance. Forty-eight gave a clear history of allergy and 30 had allergies affecting the skin. Forty women out of io6 were taking the contraceptive pill, representing 37-7 per cent (Table I).

In the course of studying keratoconus patients, fibrillar structures lying immediately inside Fleischer's ring have been observed. Their arrangement is thought to be characteristic of this condition. They lie at the level of the subepithelium and are identical in form but not in arrangement to similar structures in the normal cornea. These are described in the preceding paper (Bron, 1975). The present paper describes the distribution of fibrillary lines in keratoconus and how they differ from those in normal eyes. Material and methods

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The use of hydrophilic acrylates (POIYHEMA) Department at Moorfields Eye Hospital. They were fitted and followed up for a 9-month period.The data obtained are set out in Tables I to V. As might be expected, most of the patients were in the 50 to 70-year age group and showed degenerative or senile cataract. The waiting list for cataract operations was about equal for each sex, but the referrals for contact lenses included a greater number of males (Tables I and II).