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Understanding Keratoconus: Symptoms, Causes, and Treatment Options

Jerome Albert Ecker | MD

Medically reviewed by Jerome Albert Ecker | MD, Assistant Professor of Medicine, Duke University - Durham, NC on February 14th, 2024.

Key Takeaways

  • This progressive condition typically begins between ages 10-25, causing the cornea to thin from its normal 540 microns to as little as 200 microns in advanced cases, creating the characteristic cone bulge.

  • Early signs include frequent prescription changes (especially increasing astigmatism), seeing multiple ghost images of single objects, and difficulty with night driving due to severe glare and halos around lights.

  • Eye rubbing increases risk by 3-7 times by weakening corneal collagen fibers—patients with allergies, eczema, or sleep apnea are particularly susceptible due to chronic rubbing habits.

  • Corneal crosslinking with riboflavin and UV light can halt progression in 90% of cases when performed early, but becomes less effective once vision drops below 20/40.

  • Rigid gas permeable contact lenses remain the gold standard treatment, providing 20/20 vision in 70% of mild to moderate cases, while only 10-20% of patients ultimately require corneal transplantation.

Keratoconus is a condition that affects the shape of your cornea, the clear outer lens of your eye. In a healthy eye, the cornea has a dome shape, like a ball. However, in people with keratoconus, the cornea becomes thin and bulges outward, forming a cone-like shape. This change in shape can cause vision problems.

What Causes Keratoconus?

The exact cause of keratoconus is unknown, but researchers believe that some people may be more likely to develop the condition due to genetic factors. Several factors may contribute to the development of keratoconus, including:

  • Family history

  • Age (usually starts in teenage years or early adulthood)

  • Certain disorders (Down syndrome, Ehlers-Danlos syndrome, osteogenesis imperfecta, and retinitis pigmentosa)

  • Inflammation from allergies, asthma, or atopic eye disease

  • Eye rubbing

  • Race (Black or Latino individuals may be more likely to develop keratoconus)

Symptoms of Keratoconus

As the cornea changes shape, it can cause various symptoms, including:

  • Blurry or distorted vision

  • Double vision when looking with just one eye

  • Halos around bright lights

  • Light streaks

  • Triple ghost images

  • Difficulty driving due to blurry vision

Understanding Keratoconus: Symptoms, Causes, and Treatment Options

Diagnosing Keratoconus

To diagnose keratoconus, your eye doctor will measure the shape of your cornea. The most common method is called corneal topography, which involves taking a photo of your cornea and examining it closely. Children of parents with keratoconus should have a corneal topography every year starting at age 10.

Treatment Options for Keratoconus

Treatment for keratoconus depends on the severity of the condition. In mild cases, new eyeglasses or contact lenses may be sufficient to correct vision problems. As the condition progresses, other treatments may be necessary, such as:

  • Rigid gas permeable contact lenses

  • Cornea collagen crosslinking (to stop the condition from worsening)

  • Intacs (implantable rings to flatten the cone shape and improve vision)

  • Cornea transplant (in severe cases when other treatments are ineffective)

It's important to note that laser vision correction surgery (LASIK) is not recommended for people with keratoconus, as it can further weaken the cornea and worsen vision.

If you suspect that you or a family member may have keratoconus, consult an eye doctor for a comprehensive eye exam. Early detection and treatment can help manage the condition and preserve your vision.

For more information on keratoconus, visit:

The Bottom Line

Early intervention with corneal crosslinking can prevent vision loss in 9 out of 10 patients, making prompt diagnosis crucial when symptoms first appear. Children with family history should have specialized corneal mapping starting at age 10, even without symptoms. If you're experiencing vision changes or have concerns about corneal health, Doctronic can help connect you with appropriate eye care specialists.

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