Progressive keratoconus, retinal detachment, and intracorneal silicone oil with obsessive-compulsive eye rubbing

Abstract

An 18-year-old boy with an obsessive–compulsive disorder of eye rubbing presented with forme fruste keratoconus (KC) and posterior subcapsular cataracts. After evaluation, he underwent phacoemulsification in his left eye with intraocular lens implantation. The aggressive eye rubbing, however, aggravated the rapid progression to established KC, and further acute corneal hydrops within 3 months. Within the next 3 months, the eye rubbing precipitated rhegmatogenous retinal detachments (RDs) in both eyes. Furthermore, after undergoing a combined cataract and RD surgery with belt buckling and silicone oil endotamponade in his right eye, the repeated eye rubbing caused extrusion of the implanted silicone oil into the subconjunctival space and within the corneal stroma. This is the first report to our knowledge describing this unique complication associated with eye rubbing. It also highlights the need for increased vigilance and care that needs to be directed toward patients predisposed to such complications.

<p>TearCare^&reg; system extension study: evaluation of the safety, effectiveness, and durability through 12 months of a second TearCare^&reg; treatment on subjects with dry eye disease</p>

“…Moreover, there is the potential of altering or disrupting the eyelid anatomy. Also, there may be associations with various forms of eye rubbing or external pressure and keratoconus, retinal detachment, and other ocular conditions 25,26. On the other hand, in-office, “cold” meibomian gland expression can be uncomfortable or painful to the patient and may be limited in its ability to evacuate hardened or inspissated meibum from the glands 23…”

A novel system, TearCare^&reg;, for the treatment of the signs and symptoms of dry eye disease

“…Additionally, the risks associated with patient-administered interventions and the development of keratoconus, retinal detachment, or other ocular conditions are unclear. 25 , 26 In contrast, physician-facilitated manual “cold” expression of the meibomian glands has been reported to be uncomfortable and painful for the patient. Manual expression in the absence of an effective, heat pre-treatment is also limited in its ability to evacuate hardened meibum from the meibomian glands.…”

Genetic Aspects of Keratoconus: A Literature Review Exploring Potential Genetic Contributions and Possible Genetic Relationships with Comorbidities

“…It is accompanied by a loss of visual acuity [ 1 , 3 – 6 , 13 , 15 – 19 , 22 , 31 , 35 , 38 – 40 , 44 – 47 , 58 , 66 , 67 ] because of the distortions of the corneal curvature [ 1 , 3 – 8 , 10 , 17 – 19 , 21 , 22 , 31 , 32 , 38 – 42 , 45 , 46 , 53 , 58 , 63 , 64 ], which compromise its role in vision by distorting the refraction of light and its transmission onto the retina [ 1 ]. Corneal changes in KC also include acute corneal edema and scar formation [ 7 , 8 , 42 , 45 , 46 ], as in rare cases keratoconus presents with a central dense corneal stromal edema (hydrops) with linear oblique Descemet’s tears (ruptures in Descemet’s membrane), followed by corneal edema and scarring [ 68 ]. Finally, KC is associated with abnormal enzymatic activity within the cornea [ 38 , 69 ].…”