eMedicine Specialties > Ophthalmology > Cornea

Keratoconus: Follow-up

Author: Barry A Weissman, OD, PhD, FAAO, Chief of Contact Lens Service, Professor, Department of Ophthalmology, Jules Stein Eye Institute, University of California at Los Angeles
Coauthor(s): Karen K Yeung, OD, FAAO, Director of Optometry, Arthur Ashe Student Health and Wellness Center, University of California at Los Angeles
Contributor Information and Disclosures

Updated: Jan 8, 2007

Follow-up

Further Outpatient Care

  • Frequently observe patients with KC, especially since most wear CLs.
  • Even in the absence of signs or symptoms of complications, CL care should be provided at 4- to 6-month intervals to promptly address changes in fit or optics.
  • Patients with KC who use CLs often have a corneal abrasion, particularly if corneal steepening has made the current rigid CL fit flat. Addressing such problems may preclude increased scarring, which could necessitate PKP.

Inpatient & Outpatient Medications

Deterrence/Prevention

  • Patients should avoid eye rubbing.

Complications

  • Advanced KC 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 in one eye but usually not much pain or conjunctival injection.
    • Acute treatment of hydrops is palliative; many corneas flatten secondary to hydrops, and both visual acuity and CL application rarely may improve following such events.
    • If secondary scarring is severe, corneal transplantation (PKP) may be warranted.
  • Patients with KC develop all complications of CL wear, especially abrasion and giant papillary conjunctivitis.

Prognosis

  • Most patients with KC do well with rigid CL care.
  • About 10-20% of patients eventually require corneal transplantation, but this number is believed to increase if good CL care is unavailable.
  • Recent data suggest that this disease, although progressive, stabilizes after some time in most patients.

Patient Education

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

Miscellaneous

Medicolegal Pitfalls

  • Identification of keratoconus particularly with topography gives earlier options of contact lens or surgery.
  • Patients should approach any cosmetic refractive surgery with caution if KC is suspected or has been diagnosed.
 


More on Keratoconus

Overview: Keratoconus
Differential Diagnoses & Workup: Keratoconus
Treatment & Medication: Keratoconus
Follow-up: Keratoconus
Multimedia: Keratoconus
References
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References

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  3. Kennedy RH, Bourne WM, Dyer JA. A 48-year clinical and epidemiologic study of keratoconus. Am J Ophthalmol. Mar 15 1986;101(3):267-73. [Medline].

  4. Korb DR, Finnemore VM, Herman JP. Apical changes and scarring in keratoconus as related to contact lens fitting techniques. J Am Optom Assoc. Mar 1982;53(3):199-205. [Medline].

  5. Krachmer JH, Feder RS, Belin MW. Keratoconus and related noninflammatory corneal thinning disorders. Surv Ophthalmol. Jan-Feb 1984;28(4):293-322. [Medline].

  6. Lass JH, Lembach RG, Park SB, et al. Clinical management of keratoconus. A multicenter analysis. Ophthalmology. Apr 1990;97(4):433-45. [Medline].

  7. Macsai MS, Varley GA, Krachmer JH. Development of keratoconus after contact lens wear. Patient characteristics. Arch Ophthalmol. Apr 1990;108(4):534-8. [Medline].

  8. Maeda N, Klyce SD, Smolek MK. Comparison of methods for detecting keratoconus using videokeratography. Arch Ophthalmol. Jul 1995;113(7):870-4. [Medline].

  9. Maguire LJ, Bourne WM. Corneal topography of early keratoconus. Am J Ophthalmol. Aug 15 1989;108(2):107-12. [Medline].

  10. Moodaley L, Buckley RJ, Woodward EG. Surgery to improve contact lens wear in keratoconus. CLAO J. Apr 1991;17(2):129-31. [Medline].

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  12. Rabinowitz YS. Keratoconus. Surv Ophthalmol. Jan-Feb 1998;42(4):297-319. [Medline].

  13. Rabinowitz YS, Garbus J, McDonnell PJ. Computer-assisted corneal topography in family members of patients with keratoconus. Arch Ophthalmol. Mar 1990;108(3):365-71. [Medline].

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  16. Vogt A. Reflexlinien durch faltung spiegelnder grenzflachen im bereiche von corneo, linsenkapsel und netzhaut. Albrecht von Graefes Arch Ophthalmol. 1919;99:296-338.

  17. Wilson SE, Lin DT, Klyce SD. Corneal topography of keratoconus. Cornea. Jan 1991;10(1):2-8. [Medline].

  18. Wollensak G. Crosslinking treatment of progressive keratoconus: new hope. Curr Opin Ophthalmol. Aug 2006;17(4):356-60. [Medline].

  19. Zadnik K, Barr JT, Gordon MO, Edrington TB. Biomicroscopic signs and disease severity in keratoconus. Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study Group. Cornea. Mar 1996;15(2):139-46. [Medline].

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Further Reading

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Keywords

KC, corneal disease, stromal thinning, corneal scarring, irregular astigmatism, myopia, vision loss, Fleischer ring, Descemet membrane, intracorneal plastic rings, Intacs, corneal transplantation, penetrating keratoplasty, PKP, contact lens, contact lenses, CL, CL wear, contact lens wear, eye allergies, ocular allergies, eye rubbing

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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 at Los Angeles
Barry A Weissman, OD, PhD, FAAO is a member of the following medical societies: American Academy of Optometry and Phi Beta Kappa
Disclosure: Nothing to disclose.

Coauthor(s)

Karen K Yeung, OD, FAAO, Director of Optometry, Arthur Ashe Student Health and Wellness Center, University of California at Los Angeles
Karen K Yeung, OD, FAAO is a member of the following medical societies: American Academy of Optometry
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Hospital
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Eye Bank Association of America, Pennsylvania Medical Society, and Philadelphia County Medical Society
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other

CME Editor

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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