A Case of Early Keratoconus Associated with Eye Rubbing in a Young Child

Dimacali, Victoria; Balidis, Miltos; Adamopoulou, Aspasia; Kozei, Athina; Kozeis, Nikolaos

doi:10.1007/s40123-020-00264-8

Cited by 6 publications

(3 citation statements)

References 28 publications

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“…The majority of patients are diagnosed with KTCN at an early age, usually in the second decade of life [ 10 ]. In the youngest patients, under 10 years of age, KTCN has been reported with frequent eye rubbing and eye allergies [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Non-allergic eye rubbing is a major behavioral risk factor for keratoconus

et al. 2023

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Since the environmental, behavioral, and socioeconomic factors in the etiology of keratoconus (KTCN) remain poorly understood, we characterized them as features influencing KTCN phenotype, and especially affecting the corneal epithelium (CE). In this case-control study, 118 KTCN patients and 73 controls were clinically examined and the Questionnaire covering the aforementioned aspects was completed and then statistically elaborated. Selected KTCN-specific findings were correlated with the outcomes of the RNA-seq assessment of the CE samples. Male sex, eye rubbing, time of using a computer after work, and dust in the working environment, were the substantial KTCN risk factors identified in multivariate analysis, with ORs of 8.66, 7.36, 2.35, and 5.25, respectively. Analyses for genes whose expression in the CE was correlated with the eye rubbing manner showed the enrichment in apoptosis (TP53, BCL2L1), chaperon-related (TLN1, CTDSP2, SRPRA), unfolded protein response (NFYA, TLN1, CTDSP2, SRPRA), cell adhesion (TGFBI, PTPN1, PDPK1), and cellular stress (TFDP1, SRPRA, CAPZB) pathways. Genes whose expression was extrapolated to the allergy status didn’t contribute to IgE-related or other inflammatory pathways. Presented findings support the hypothesis of chronic mechanical corneal trauma in KTCN. Eye-rubbing causes CE damage and triggers cellular stress which through its influence on cell apoptosis, migration, and adhesion affects the KTCN phenotype.

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Section: Introductionmentioning

confidence: 99%

Non-allergic eye rubbing is a major behavioral risk factor for keratoconus

et al. 2023

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“…Keratoconus was diagnosed in much younger patients in this study as compared with other studies conducted worldwide. 7,21,38 Isolated cases were, however, reported where patients were detected in early ages of 4 years, 39 5 years 37 and 6 years, 13,23,40 and there was also presence of KC in much older persons of 57 years 21 and 67 years. 41 Keratoconus spans through pubescent years to the fourth decade of life but it has been observed to be common in patients between 20 and 30 years.…”

Section: Discussionmentioning

confidence: 98%

Keratoconic patient profile and management at public sector facilities in South Africa

Nkoana¹,

Moodley²,

Mashige³

2023

Afr. vis. eye health

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Background: Keratoconus (KC) is a condition marked by thinning and protrusion of the cornea resulting in high myopia and irregular astigmatism. Knowledge of KC patients’ profiles and management approaches used can help to predict the needs of public hospitals to improve patient care.Aim: This study aimed to describe the profiles and management of KC patients.Setting: Capricorn district, Limpopo Province, South Africa.Methods: Medical records of 188 KC patients attending public hospitals of Capricorn District from January 2017 to December 2020 were reviewed. Data on patient profile and their management were collected and analysed.Results: The mean age of KC patients was 20.64 ± 6.82 years and the majority (56.9%) were males. Clinical findings were mean unaided visual acuity (UVA) of 0.19 ± 0.18, best corrected VA of 0.53 ± 0.24, spherical equivalence of -4.89 ± 9.17 dioptre (D), mean K of 57.37 ± 17 D and corneal astigmatism of -6.24 ± 4.27 D. A total of 54.5% of patients had severe KC. Bilateral KC was found in almost all patients (97.3%) and a mean K difference of 7.59 ± 6.08 D (p 0.001) between the better and the worse eye. The study found no significant difference in KC severity by age (p = 0.451) and gender (p = 0.819). Patients fitted with scleral lenses had the highest VA improvement of 0.44 ± 0.17.Conclusion: Most patients presented with bilateral and severe KC. Scleral lenses provided higher VA improvement than other methods.Contribution: The study aimed to present the clinical profile and management of keratoconic patients attending public sector facilities. Knowledge of the patterns of KC presentation may assist in the development of intervention strategies and guidelines for best practice in the management of KC, especially in public sector facilities.

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“…Several reasons might explain the discrepancy in DS patients and KC's prevalence, including the clinical equipment utilized, ethnicity, the lack of cooperation from patients during screening, the diagnostic criteria for KC, sample size, and the patient's age during clinical examinations (<18 years) [30,42,59,60]. It is well known that KC manifests itself throughout the adolescent years, although some are reported to have an onset <10 years old [5,[61][62][63][64]. In a study by Alio et al, the authors noted that approximately 75% of 112 DS patients, comprising 59% Caucasians and 41% Arabs, demonstrated corneal features likely to be characteristic of KC [30].…”

Section: Ophthalmic Manifestations Of Down Syndromementioning

confidence: 99%

The Underlying Relationship between Keratoconus and Down Syndrome

Akoto

Estes

et al. 2022

IJMS

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Keratoconus (KC) is one of the most significant corneal disorders worldwide, characterized by the progressive thinning and cone-shaped protrusion of the cornea, which can lead to severe visual impairment. The prevalence of KC varies greatly by ethnic groups and geographic regions and has been observed to be higher in recent years. Although studies reveal a possible link between KC and genetics, hormonal disturbances, environmental factors, and specific comorbidities such as Down Syndrome (DS), the exact cause of KC remains unknown. The incidence of KC ranges from 0% to 71% in DS patients, implying that as the worldwide population of DS patients grows, the number of KC patients may continue to rise significantly. As a result, this review aims to shed more light on the underlying relationship between KC and DS by examining the genetics relating to the cornea, central corneal thickness (CCT), and mechanical forces on the cornea, such as vigorous eye rubbing. Furthermore, this review discusses KC diagnostic and treatment strategies that may help detect KC in DS patients, as well as the available DS mouse models that could be used in modeling KC in DS patients. In summary, this review will provide improved clinical knowledge of KC in DS patients and promote additional KC-related research in these patients to enhance their eyesight and provide suitable treatment targets.

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A Case of Early Keratoconus Associated with Eye Rubbing in a Young Child

Cited by 6 publications

References 28 publications

Non-allergic eye rubbing is a major behavioral risk factor for keratoconus

Non-allergic eye rubbing is a major behavioral risk factor for keratoconus

Keratoconic patient profile and management at public sector facilities in South Africa

The Underlying Relationship between Keratoconus and Down Syndrome

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