Keratoconus Follow-up

  • Author: Barry A Weissman, OD, PhD, FAAO; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Nov 23, 2011
 

Further Outpatient Care

Frequently observe patients with keratoconus (KC), especially because most wear contact lenses (CLs).

Even in the absence of signs or symptoms of complications, contact lens care should be provided at 4-month to 6-month intervals to promptly address changes in fit or optics.

Patients with keratoconus who use contact lenses often have a corneal abrasion, particularly if corneal steepening has made the current rigid contact lens fit flat. Addressing such problems may preclude increased scarring, which could necessitate penetrating keratoplasty (PKP).

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Inpatient & Outpatient Medications

See Medication.

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Deterrence/Prevention

Patients should avoid eye rubbing.

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Complications

Advanced keratoconus rarely progresses to acute corneal hydrops (acute keratoconus), wherein breaks occur in the Descemet layer that lead to central stromal edema and secondary severe corneal scarring.

  • Patients report a sudden loss of vision and some ocular discomfort or pain in one eye but usually not much conjunctival injection.
  • Acute treatment of hydrops is palliative; many corneas flatten secondary to hydrops, and both visual acuity and contact lens application may rarely improve following such events.
  • If secondary scarring is severe, corneal transplantation (ie, PKP) may be warranted.

Patients with keratoconus develop all complications of contact lens wear, especially abrasion[30] and giant papillary conjunctivitis. Contact lens–related secondary giant papillary conjunctivitis may be treated with topical mast cell stabilizers, antihistamine, and, occasionally, steroid drops.

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Prognosis

Most patients with keratoconus do well with rigid contact lens care.

About 10-20% of patients eventually require corneal transplantation,[15] but this number is believed to increase if good contact lens care is unavailable.

Data suggest that this disease, although progressive, stabilizes after some time in most patients.

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Patient Education

Patients with keratoconus and their family members probably should receive genetic counseling.

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Contributor Information and Disclosures
Author

Barry A Weissman, OD, PhD, FAAO  Chief of Contact Lens Service, Professor, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine; Adjunct Professor of Optometry, Southern California College of Optometry

Barry A Weissman, OD, PhD, FAAO is a member of the following medical societies: American Academy of Optometry, American Optometric Association, California Optometric Society, and International Society for Contact Lens Research

Disclosure: VSP None Speaking and teaching; Alcon None Speaking and teaching; Vistakon/The Vision Care Institute Grant/research funds support of Fellowship program

Coauthor(s)

Karen K Yeung, OD, FAAO  Director of Optometry, Arthur Ashe Student Health and Wellness Center, University of California, Los Angeles, David Geffen School of Medicine

Karen K Yeung, OD, FAAO is a member of the following medical societies: American Academy of Optometry

Disclosure: Nothing to disclose.

Specialty Editor Board

Fernando H Murillo-Lopez, MD  Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; RPS Ownership interest Other; EyeGate Pharma Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting; Merck Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

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An optic section of a keratoconic cornea shows corneal thinning. Vogt striae and some scarring can also be seen centrally; superiorly, a small (brown) section of the Fleischer ring is noted.
The fluorescein pattern of a rather flat-fitted rigid contact lens on an advanced keratoconic cornea.
 
 
 
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