Keratoconus is a progressive disorder where the cornea thins and protrudes into a cone shape, usually developing during puberty and progressing until the 3rd-4th decades. It affects both eyes and causes vision impairment from irregular astigmatism and myopia. Diagnosis involves examining for signs of stromal thinning, protrusion, striae, Fleischer ring, and steep keratometry readings. Treatment ranges from glasses and contact lenses in early stages to keratoplasty for severe scarring.

1. Dr. Christina

2.  Progressive disorder in which the cornea
assumes a conical shape secondary to corneal
thinning and protrusion
 Onset is around puberty- progresses untill 3rd
or 4th decades of life
 Both eyes affected usually
 Role of hereditary transmission is not clear.

3. PRESENTATION
 Presents usually during puberty.
 Impairment of vision due to progressive
myopia and irregular astigmatism.
 Asymmetrical nature.
 Approximately 50% of normal fellow eyes will
progress to keratoconus within16 years.

5. DIAGNOSIS
 Central or paracentral stromal thinning,
apical protrusion and irregular astigmatism
SIGNS:
 Direct ophthalmoscopy shows ‘oil droplet
sign’.
 Retinoscopy shows irregular’ scissor’ reflex’
 Slit lamp microscopy showsfine, vertical,
deep stromal striae called vogts striae .

6.  Epithelial iron deposits may surround the
base of cone –’fleischer ring’.
 Marked irregular myopic astigmatism with
steep keratometry reading.
 Bulging of the lower lid in down gaze-
‘munson sign’.
 Corneal topography – sensitive method of
detecting early keratoconus.

7. ACUTE HYDOPS
 Caused by rupture of descemets membrane
that allows influx of aqueous into the conea.
 Causes sudden drop in visual acuity with
discomfort and watering.
 Usually the break heals within 6-10 weeks and
edema clears but scarring results
 Treatment is keratoplasty after edema
resolves.

9. ASSOCIATIONS
 SYSTEMIC DISORDERS LIKE Down, Turner,
Ehler-Danlos and Marfan syndromes, atopy,
oesteogenesis imperfecta, MVP, mental
retardation.
 OCULAR DISORDERS like vernal kerato
conjunctivitis, blue sclera, aniridia, ectopia
lentis, RP

10. TREATMENT
 Spectacles in early stages.
 Rigid contact lenses for higher degrees of
irregular astigmatism..Piggy back lenses.
 Keratoplasty : both lamellar and penetrating
keratoplasty especially in cases of severe
corneal scarring.

11. THANK YOU