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Eye rubbing: the root cause of Keratoconus?

The sine qua non of keratoconus: the eye rubbing

The repeated eye rubbing have been recognized for a long time as a risk factor for the Keratoconus, but I am convinced that their role in the pathogenesis of Keratoconus has been largely underestimated. I started to write an article to explain to interested readers the pathophysiological concept originally from Keratoconus which I am convinced: The chronic and repeated eye rubbing are the primitive, necessary and sufficient cause, i.e. the condition prerequisite not for Keratoconus: no frictions, no Keratoconus ("no rub, no cone")

Eye rubbing causes the keratoconusRead the articles: Are the eye rubbing the sine qua non of Keratoconus D Gatinel cause

Keratoconus: the necessary and sufficient condition eye rubbing? Realities OPH September 2016

See also: (original article in English)

Visit the site and see many illustrated clinical case and examples of keratoconus: https://defeatkeratoconus.com/

Keratoconus is classically defined as dystrophy of origin unknown, responsible for a deterioration of vision. This is due to the deformation of the corneal dome, that causes a astigmatism Irregularity and myopia. Many clinical examples of keratoconus are gathered on the site dedicated to the fight against the Keratoconus https://defeatkeratoconus.com/portfolio-filtersearch/. I have always been captivated by this disease whose origin remains mysterious; A large part of my clinical practice is dedicated to the diagnosis, management and prevention of keratoconus, and for many years I was intrigued by the importance of structural changes and the deformation of the corneal wall in the Keratoconus. Paradoxically, few genetic or molecular anomalies have been detected in this condition, whose consequences on the regularity and transparency of the cornea can, however, be spectacular.

In this article, I propose the theory that Keratoconus is not unknown to genetics and Biomolecular bedrock dystrophy, but rather a syndrome of mechanical origin originally caused by the rubbing of the eyes. Drought, eye irritation, pollution, night work and on screen, where under special conditions (irritating particle, dust, mites introduced by a Sleep position with deep support of the head against the pillow) are all factors that can cause eye itching and the desire to rub your eyes. How many ophthalmological consultations are motivated by "itchy eyes"?

"So, what was called" Keratoconus "could just be the direct consequence of the mechanical trauma of the cornea caused by chronic and constant eye rubbingcausing the deformation and thinning progressive corneal wall, which are characteristic of the disease. The eye rubbing are at the heart of this «» "mechanical" hypothesis as the etiology of Keratoconus.

Etiology of the keratoconus

The mechanical hypothesis argues that Keratoconus is caused by the eye rubbing. These can themselves be induced by atopy, pollution, labor extended on screen... Unlike the molecular hypothesis where of supposed genetic, environmental or unidentified factors would play a key role in the appearance of Keratoconus, the mechanical hypothesis States simply that the structural changes and the deformation of the cornea are initiated and exacerbated by a mechanical cause : eye rubbing. Other factors of mechanical origin, such as the corneal refractive surgery, or the night extended compression of the cornea (pillow, hand or forearm) are likely to accelerate the deformation of the cornea. The eye rubbing can cause local inflammation with release of pro-inflammatory molecules. The effect of mechanical stress (distension) can be potentiated by the secretion of proteinases in the corneal stroma, which could explain the progressive thinning of the cornea, and make it even more vulnerable to the effects of friction. In the mechanical hypothesis, Keratoconus can occur without the repeated mechanical trauma that are rubbing. When the duration and intensity of these exceed the threshold of biomechanical resistance of the cornea, it deforms gradually, which causes the appearance of the characteristic topographic anomalies ranging from crude said forms to the most proven forms of Keratoconus. In my experience, the most advanced forms of Keratoconus with stromal opacities, still meet in the patient who rub the eyes of particularly strong way.

Keratoconus: a mechanical pathology

Just as an excessive distension of the ligament of the ankle can cause a sprain, chronic eye rubbing can reduce the biomechanical resistance of the mesh of collagen fibers in the corneal dome, and lead to the distortion of it. This biomechanical mechanism is more likely to account for the disparity between the achievement of the right eye and left (patients rub often more one look than the other), and the focal nature of Keratoconus, which has recently been highlighted.

 

Genetics of Keratoconus is unclear. The frequency of occurrence within members of the same family are not clearly defined and would be slightly less than 20%. In the hypothesis where the friction are essential to the genesis of the affection, the genetic factors involved are rather related to conditions that predispose to the eye rubbing, or that control the thickness and resistance of the cornea. These conditions include diseases as diverse as Trisomy 21 and atopy. Sleep apnea has been associated with Keratoconus. The lack of quality sleep provides chronic fatigue and fatigue is likely to drive patients to rub their eyes. I met the case of patients who had a Keratoconus of installation late (after 30 years), due to a schedule change (night work) causing chronic fatigue, and the repetitive urge to rub their eyes. A sex ratio slightly biased in favor of men was reported recently for Keratoconus. In my experience, women who wear makeup tend to less rubbing the eyes than men. However, these rub sometimes eye after removal of make-up. Dry eye increases during pregnancy, due to certain hormonal changes: drought-induced irritation can cause the urge to rub their eyes. This could explain the progression of Keratoconus during pregnancy, and the fact that it has been identified as a risk factor for post LASIK ectasia. It is all case easier to explain the significant disparity of age, hit between the eyes, and the wide range of phenotypic expression by eye rubbing repeated by a corneal degeneration genetics and the unidentified molecular mechanisms. For the same intensity and the same amount of friction, the cornea which is less the thickness and resistance may undergo a deformation greater than more strong and thick corneas. Exposure to high degree of pollution and dryness of the air, combined with a bad environmental conditions or work may explain the increased prevalence of Keratoconus in certain ethnic groups. The explosion of work on screen and the generalization of the screens led to the emergence of a disease called "Computer Vision Syndrome" (which can be translated as 'Labour on screen Syndrome'). It includes eye fatigue chronic source of irritation and eye pruritus, which can lead to a repeated eye rubbing and play an important role in the increase in the prevalence of Keratoconus.

Genetics of Keratoconus is unclear. The frequency of occurrence within members of the same family are not clearly defined and would be slightly less than 20%. In the hypothesis where the friction are essential to the genesis of affection, the genetic factors involved would be rather related to conditions that predispose to the development of the eye rubbing, or that control the thickness and resistance of the cornea. These conditions include diseases as various as Trisomy 21 and atopy (source of eye pruritus). Sleep apnea has been associated with Keratoconus; the lack of quality sleep provides chronic fatigue and fatigue is likely to drive patients to rub their eyes. I saw the case of patients who had a Keratoconus of installation late (after 30 years), due to a schedule change (night work) causing chronic fatigue, and the repetitive urge to rub their eyes. A sex ratio slightly biased in favor of men was reported recently for Keratoconus. In my experience, women who wear makeup tend to less rubbing the eyes than men. However, these rub sometimes eye after removal of make-up. Dry eye increases during pregnancy, due to certain hormonal changes: drought-induced irritation can cause the urge to rub their eyes. This could explain the progression of Keratoconus during pregnancy, and the fact that it has been identified as a risk factor for ectasia post LASIK. Ocular rosacea is also source of discomfort and eye pruritus, where prescribed massages of the eyelids. I met a case of bilateral Keratoconus triggered by bad maneuvers of hygiene of eyelids, leading the patient to rub your eyes every day, leading to the appearance of a characteristic distortion in a few months.
It is all case easier to explain the significant disparity of age, hit between the eyes, and the wide range of phenotypic expression by eye rubbing repeated by a corneal degeneration genetics and the unidentified molecular mechanisms. Fortunately, all patients who rub their eyes do not develop Keratoconus. For the same intensity and the same amount of friction, the cornea which is less the thickness and resistance may undergo a deformation greater than more strong and thick corneas. Exposure to high degree of pollution and dryness of the air, combined with poor environmental conditions or work may explain the increased prevalence of Keratoconus in certain ethnic groups. 
The explosion of work on screen and the generalization of the screens led to the emergence of a disease called «» Computer Vision Syndrome "(that can be translated as 'Labour on screen Syndrome'). It includes eye fatigue chronic source of irritation and eye pruritus, which can lead to a repeated eye rubbing and play an important role in the increase in the prevalence of Keratoconus.

 

Vs Keratoconus Marfan syndrome

The comparison between violations eye, especially corneal of Marfan syndrome, and those observed for Keratoconus is a particularly important point for our argument. All the necessary ingredients for a Keratoconus induction are present in this condition, which the main features of the corneal expression flow from a biomechanical weakening of the corneal collagen. Yet, strain typically encountered during Marfan syndrome is not really like what is observed in Keratoconus.

Marfan vs keratoconus

Marfan syndrome is a genetic disease that affects the connective tissue first. It is caused by the mutation of a gene that controls the production of a protein called fibrilline-1, which is widely held within the connective tissue, particularly at the level of the collagen fibrils. This syndrome affects many organs, including the eye. It can lead to the appearance of an aneurysm of the aorta, due to the weakening of the wall of it, subject to the pressure of blood flow. The ectopy (displacement) of the lens is a classic manifestation of Marfan syndrome, as constituting the cristallinien ligament fibers weaken and eventually break.
Marfan syndrome is a perfect counterexample to emphasize failure have current theories to explain the pathophysiology of Keratoconus. These theories link the origin of Keratoconus with unknown collagen dystrophy associated with environmental, cellular and genetic factors. The combination of these factors would be at the origin of the corneal degeneration, we know well what would be the common denominator for triggering the process of al wall corneal ectasia. However, Marfan syndrome responds perfectly to this type of Pathology; a genetic mutation has been identified, and the mutated protein (fibrilline-1) causes the decrease in the resistance of collagen of the eye tissue, including the corneal stroma. However, despite all these favorable characteristics to the outbreak of a corneal distortion, there is no occurrence of an ectasia or Keratoconus in Marfan syndrome. The corneas of patients certainly tend to be thinner, but also flatter, and either assemblies. This reduction of camber is not paradoxical if it is agreed that under physiological conditions, the eye pressure is evenly on the inner surface of the corneal dome. This force, resulting from the distribution of intraocular pressure on the inner wall of the sclera and the posterior face of the corneal, causes a progressive distension of the eyeball, and thus a reduction of the camber of the cornea (by increase of its radius of curvature), as well as its concomitant thinning.
Without the input of an external force, the biomechanical weakening of the cornea as in Marfan syndrome leads to flattening of the. Ocular distension causes also the increase in ocular axial length, and as a result, the majority of patients with Marfan syndrome are short-sighted. The presence of axile myopia associated with a flattening of the cornea are two eye criteria for positive diagnosis of Marfan syndrome.
An association between Keratoconus and Marfan syndrome has been reported; It is not contradictory with the mechanical theory of Keratoconus. The cornea is more fragile in this syndrome, she is more likely to deform quickly under the effect of eye rubbing.
Contrary to what is observed for Marfan syndrome, patients with Keratoconus the cornea is more arched and asymmetrical, and has thinning of focal nature, central or lower central para. The use of an external force is better able to account for this type of table than an unidentified molecular anomaly who would reach the cornea as a whole, but would save the other tissues of the body. The force exerted by the digital friction, especially the knuckles against the cornea is considerable scale of it. It causes the stretching and the disorganization of the collagen fibers of the cornea. The increase in acute and repeated intraocular pressure can cause a distension of the sclera and an elongation of the eyeball. To corroborate this observation with the induction of a repeated pressure elevation intraocular suites in support of fingers for rubbing, it seems that the average axial length of patients with Keratoconus is slightly higher than that of free patients of Keratoconus.

Thus, in this clinical model where the cornea is undoubtedly reached in biomechanical terms, there is a reduction of its curvature (global Flattening). Moreover, it is interesting to observe that corneal disorders caused by inflammatory mechanisms are characterized also by a reduction of the curvature. Scars post infectious or interesticielles keratitis or interface (after LASIK) are usually accompanied by a decrease in the keratometry central or paracentrale, and this trend is evidemement opposite to that of Keratoconus.

The mechanical hypothesis can naturally generate distrust and skepticism, because it is both simple, provocative, and difficult to demonstrate. However, it would also be, see more difficult to prove that the friction are not the cause of Keratoconus.

The purpose of this article to raise it, defend it, but also to publicize the deleterious effects of the eye rubbing the impact of Keratoconus. Whatever the primitive mechanism originally of Keratoconus, emphasise the causal role of friction can only initially reduce the impact, and to stop the progression.

In conclusion: 

The assumption of friction as the cause sine qua non the Keratoconus defies the widely accepted concept of corneal dystrophy of unknown origin. It will appear simplistic or provocative for sure, and would have even raised my scepticism even 6 or 7 years ago. This scepticism is however today dispelled by the accumulation of clinical observations that confirm one by one the central role of the eye rubbing as a factor triggering of Keratoconus. In the end,. I think even the mechanical theory of friction is able to raise the mystery of the mystery that surrounds the Keratoconus, and could close the chapter opened in 1854 by Dr. John Nottingham and his treatise on the "conical cornea"..

If the removal of the eye rubbing could eradicate the Keratoconus and reduce the risk of ectasia corneal LASIK post, from a point of view practice, this goal is probably unattainable. It is very likely that some patients cannot resist the judged urge to rub their eyes when they "scrape". When the diagnosis of Keratoconus has been laid, to the occaseion of the balance sheet of a decline in vision, it is however necessary to carry out a survey to become aware of the friction, identify their cause to better treat.

Nevertheless, the less ambitious goal of reducing the size and frequency of the eye rubbing patients likely to develop Keratoconus, or see their condition progress is an essential issue. Before any patient suffering from Keratoconus, I take time to well conduct interrogations intended to search for the existence of eye rubbing, and insists in a vehement manner on the importance of their strict stop, which is a major point to stop the progression of the disease.

It is important to document the possible progression of Keratoconus in refractive and topographic terms. My experience shows that the judgment of the eye rubbing enough to stop evolution of Keratoconus, and this objectively, comparing topographic surveys at each visit and by subtractive maps. The prospective collection of topographic data in patients followed at the Rothschild Foundation is very encouraging, and confirms that the judgment of friction stops indeed the evolution of Keratoconus. The results of this monitoring should be documented to ensure that stability over the long-term, but if they are confirmed, they will provide a strong argument for sit the mechanical hypothesis and confirm that Keratoconus could never have been a real dystrophy, but be a syndrome which refractive and topographic expression is the result of a mechanical stress of the cornea: the eye rubbing repeated.

(Comments are welcome)

51 answers to":eye rubbingTHE primitive cause of the keratoconus?"

  1. Jose says:

    Bravo for this interesting explanation, which corresponds to my story, I have Keratoconus since more than 10 years, I wear rigid lenses. Since I have these lenses I can't rub my eyes, but I had started to do so around the age of 15 years, and we found my illness during a control to work for hire, I had astigmatism for the first time in 18 years. At first, my eye doctor gave me glasses, but he never told me do not rub. It's the lenses specialist, who explained to me that I should never touch the eyes, especially for don't not to damage the lenses. I read your site then and I realized that it had to do also with my illness, because it really showed up after I started scratching my eyes, I was asmatique too. I have a 4 year old boy and I prevents rubbing when he says that ca scratches, I hope that as his mother, he will never have Keratoconus.

  2. Dr. Damien Gatinel says:

    Thanks for your comment, if I believe in my theory, then Yes, if your child don't rub eyes (at least not too often and not too strongly), it should logically escape the onset of Keratoconus. I actually advocating the ouster of the eye rubbing in all children, especially those who have allergies, and are likely to do. Local treatment, or desensitizing, and good information of the risks associated with this practice are indicated.

  3. Dauthuile says:

    Nice presentation indeed and which raises the etiology (the etiologies of the KC). The team follows 5-7 keratoconiques per week for years, and it is certain customers who lose the habit of rubbing the eyes because of the loss of their lenses to see the evolution of their KC decrease. It often said that it was the LRPG who had this action...
    Kind regards
    Pascale

  4. Henry says:

    Hello thanks for this analysis. How do you explain the fact that there are families of Keratoconus? We are four brothers and sisters, I'm reaching, as well as my brother- but not my sisters. I was always told that there are genetic factors and Keratoconus is genetic?

  5. Dr. Damien Gatinel says:

    There are indeed genetic clues for Keratoconus. Some studies point to parts of certain chromosomes... but we must insist on the fact that no gene has been identified to date, and that only 20% of the forms of KC appear to have a genetic dimension. The fact that your sisters unhurt affection shows that genetics do not explain everything, the heredity of the KC is obviously not related to sex. It is just possible that your sisters are less rubbing the eyes (makeup, etc.).
    It is possible that some genetic factors play a predisposing role, making the cornea more vulnerable, finer, or simply promoting an atopic terrain.... My point of view is not that there are only frictions that are incriminated for the keratoconus, but that they are indispensable for the emergence of the corneal distortion typically encountered in what is referred to as "Keratoconus". On the contrary, and fortunately, all patients who rub a little too much the eyes will not develop the disease, although they often observe minor alterations of the corneal relief in topography.

  6. Abbou says:

    Hi currently I have a right eye Keratoconus, left it is low. My doctor never told me not to rub your eyes, but it's true that it's been 3 years now that I do the allergy and I rubbed a lot, before I had a view (perfect 10/10 2-eyed). I rub the eye that itches too, especially in the morning. I'll try to stop but I would have liked to be informed more tot. My little brother also rubs his eyes, I tell her to stop doing. Thank you for your informative article.

  7. Dr. Damien Gatinel says:

    Wear lenses will not hinder in my opinion the evolution of the KC that equipped patients or less rubbing the eyes otherwise to move or down the lens. This does however not some to rub vigorously to the withdrawal of these, or even in the morning, etc.

  8. Beldjilali says:

    Hello how do you explain that patients with severe allergic conjunctivitis so that rub the eyes constantly do not develop a keratoconus? ??????

  9. Dr. Damien Gatinel says:

    The speed of onset of Keratoconus depends on the frequency of the friction, their intensity, of the part of the used hands (palms, fingers, fingertips), reported to the resistance of the native of the cornea, which is itself a function of the thickness and quality of the stromal collagen. From my point of view, all patients with Keratoconus are rubbing the eyes, but all patients who rub their eyes don't have Keratoconus.
    However, more or less pronounced deformations in corneal topography are commonly observed in "eye-scrubbers". The parallelism between the severity of these deformations and the intensity of friction is quite eloquent. These topogrpahiques anomalies often generate positivity from the detection indices of keratoconus ex: Keratoconus suspect, fruste, etc. Thus, without going as far as the keratoconus proved, patients who often rub their eyes show atypies topgraphiques more or less pronounced.

  10. Charles says:

    Hello doctor.
    I would like to know whether stopping to rub the eyes will render the cornea its normal topography in the so-called crude forms of the keratoconus. If so dadans what delay. Thank you

  11. Dr. Damien Gatinel says:

    In general, stop rubbing can stop the progression, but the deformations caused by these earlier persist. However as usual a small adjustment of the topography when friction cease. But in the forms where there has been a modest but proven topographic distortion (ex: asymmetry), a normalization is not possible in a spontaneous way.

  12. Sophie says:

    Hello

    My husband, his brother, his father and his grandfather are all affected by a bilateral Keratocône.
    On the other hand the evolution is very different from one person to another: little advanced for my husband (33 years, correction with glasses, CXL envisaged on continuous evolution), stage 4 for his brother (28 years, almost blind, he is on waiting list for a transplant, to Long term his two eyes will be grafted).

    I have two children of 2 and 4 years followed each year for a ophthalmologist, and we intend to bring them to a specialist of the Keratocône for screening from 8 years.

    I have difficulty thinking that the risk of transmission is only 10% as it is mentioned on the sites on the keratoconus to the views of the 3 generations reached my husband's side.
    Do you know more about the risks my children have of developing this disease?

    Knowing the risks, if they were to be reached, they will be tracking very early. Does early management reduce the risk of disabling vision loss on a day-to-day basis? I am very concerned about this risk of disability.

    And I will of course follow your advice and teach them to rub their eyes as little as possible.

    Thanks in advance, cordially

  13. Dr. Damien Gatinel says:

    The vast majority of the case of keratoconus are sporadic, i.e. observed outside of a genetic context (parents, siblings are unscathed when discovering a keratoconus in a subject). There are, of course, forms where the disease affects several members, as in your family, but these case are minority. They are explained by the existence of environmental and/or genetic factors conducive to the onset not of keratoconus, but of repeated eye rubbing. Atopic sites have a certain genetic determinism, and some (thinner) corneas have less resistance, the corneal thickness also appears to be influenced by genetic factors. The stage of the keratoconus arises from an equation involving the duration, frequency, and intensity of the eye rubbing. Your brother-in-law, if he is at an advanced stage, probably rubs his eyes a lot, without being able to stop himself. If your husband ceases this habit, he will no longer progress, and your children, if they learn not to rub their eyes (but gently wipe or moisturize them), will not develop corneal disease. This is not always easy, children are often frequent "scrubbers", especially if they suffer from allergy. It is important to conduct a allergic review, and to consider desensitization if necessary.

  14. Ivan says:

    Hello
    Are you reluctant to use the orthokeratology to improve the surface of a cornea affected by the Kératocone?

  15. Dr. Damien Gatinel says:

    No, provided that this technique does not induce a desire to rub the eyes (and therefore more important or renewed frictions).

  16. Jessica says:

    Hello, my keratoconus developed after a long and hard childbirth at 23 years. It was at the return of my maternity leave at work that I noticed the fall of my sight. My KC was very evolutionary. In reading your article, I remember: that every waking morning my mom would say "stop rubbing your Eyes", it itches me so much that I rub them even on the stairs. Today I am equipped with Scérale lenses because of chronic drought for 1 month, I support them much better than rigid or hybrids. I am obligated to hydrate regularly. Question: I had read an article that makes a correspondence between the low rate of Vit D and the KC. At home I do not fix vitamin D even if I do a cure for several weeks or if I take a drop daily... my rate of Vit D increases a little and then relapse gradually. Do you have any information on this? Because physically it is very rare that I am in great shape, I am all the time very tired. Thank you

  17. Caillaud says:

    Good evening
    We just learned from a check-up consultation that our 16-year-old son has a keratoconus. Three years ago he had nothing. For 3 years he has developed important seasonal allergies during which he rubs his very irritated eyes, necessitating eye drops. The link you establish is very interesting. We will consult the CHU of Brest to establish the treatment to be driven.

  18. Dr. Damien Gatinel says:

    In my experience, all keratoconus are preceded by a history of sustained eye rubbing. As explained on these pages, friction is a necessary ingredient for the appearance of a keratoconus. We have gathered many case, all exemplary, of keratoconus on this site: https://defeatkeratoconus.com/ . Frictions made with fists (phalanges) are the most deleterious. In my practice, I always advocate at first the strict and definitive stop of friction, which can be facilitated by the prescription of a local anti-allergic treatment, moisturizing eye drops, desensitization... As you will see, All the case we follow are stable as soon as the friction stops. Sometimes it is advisable to wear protective shells at night (patients sleeping on the belly or side, pressing their eyes...). The keratoconus can be followed by maps of differential topographies: they are used to demonstrate objectively the stability of keratoconus in patients who permanently stop rubbing their eyes. This affection (the Keratoconus), which has been a mystery for more than two centuries, is in fact only the expression of a corneal distortion of mechanical origin, which affects some patients who rub their eyes in a pronounced and prolonged manner.

  19. Dr. Damien Gatinel says:

    There is no real causal link between vitamin D deficiencies and keratoconus. However, it is not impossible for this deficiency to be associated with certain immune disorders such as allergy/atopy, and it would then be the hidden variable leading to an increased risk of KC, but through eye rubbing. It is not your fault that the keratoconus appeared, because it is difficult to suppress the eye rubbing, and there are still practitioners who doubt the liability of friction in the appearance of the keratoconus. In fact, there is still insufficient information, and too many interventions are being proposed in an abusive manner. I postulate that friction is the cause of keratoconus, and that this disease is a corneal deformation of mechanical origin that occurs in particular contexts... and on the other hand, in the absence of friction, there is no risk of Keratoconus. It is important not to rub your eyes at all.

  20. Philippe says:

    Mr. Ganeshan, your scientific mind and intellectual honesty is a pleasure to read. Advocating the cessation of friction will certainly bring much less financial profits than the practice of crossliking charged 700 euros but the benefit for the patient is priceless. For my part, I have long scratched my eyes because of seasonal allergies or these have decreased 3/4 when I stopped cow's milk and its derivatives. And I notice that my keratoconus only evolves if for several days in a row I scratched my eyes (for example if I consumed nuts or eggs...). But we have to go further I think the mere eviction of certain foods allergenic (specific to each although large constants are visible). Because if certain foods (and also environmental causes such as pollution) have to be ousted, the even deeper cause of allergy could come, according to the latest research, from a disordered bowels. And these deregulations, in the sight of our modern diet based on excess sugar mainly, are the cause of the causes to be treated it seems to me (of which to make laugh your confreres!). Thanks again for your research which confirms to me what I experimented empirically and which has earned me to be excluded in particular from discussion group on the subject of the keratoconus or even to be considered with some form of condescension by some of your Colleagues in the office. Fortunately science evolves thanks to people like you who know how to put their prejudices aside in order to make the problem advanced from a point of view motivated by the only search for truth.

  21. Dr. Damien Gatinel says:

    Thank you for your encouraging comments. I appreciate your personal contribution to illustrate the major role of eye rubbing in the Génese and progression of keratoconus. It ejoint a number of particularly "edifying" observations on this subject, the study of which can only reinforce this belief (these case have been grouped here: Indeed, your particular case, if isolated, would not allow the fact that the friction is indispensable to the keratoconus alone. However, all KC patients have a history of vigorous and repeated friction; It is enough to study these case and not to be content with a summary interrogation. The case for which the KC is unilateral or much more marked on one side than the other are precious because very informative: in these situations, the eye reached is the only one (or the one that is by far the most) rubbed. Sleep position is also a certain risk factor; That is to say sleeping in support of the eyes (or an eye), what happens when one sleeps on the side or on the belly. This probably triggers the urge to rub one eye or both (irritation, contamination) and makes the cornea more susceptible to rubbing (increasing local temperature). But if we broaden the table, I share your opinion, and it is important to understand all the causes that can lead to immune deregulation and the occurrence of allergies. Diet is certainly a potential vector of allergy, like all physiological mechanisms that lead to the interaction between exogenous molecules and the body's cells (including those of the immune system). I smiled when I read that you were excluded from a discussion group on the KC, because I also experienced such a mishap;) Many patients with KC have a legitimate anxiety and a sense of injustice with respect to this condition that can be very handicapping in everyday life, and deleterious to self-esteem. They confuse the fact that they may have been directly "at the origin" of their keratoconus with a charge, or fear that the recognition of the mechanical etiology of keratoconus leads to a "dereimbursement" or a lesser care and Consideration of the disease. It is quite obvious that the information on friction is relatively recent, and that if there is a brake on its diffusion, it is more to account for ophthalmologists who received a teaching presenting the KC as a condition primitively Genetic or sporadic and unknown cause. I dare to believe that some might be at the bottom convinced of the direct responsibility of friction but continue to deny their importance in continuing to propose a CXL that is a bad answer to a erroneous question. It is not actually appropriate to attempt to harden a natively softened cornea, but to prevent or interrupt the occurrence of the repetitive and repeated trauma, which can strike a person indiscriminately. Many researchers in the field have devoted an important part of their work to trying to identify a specific genetic mutation, or elucidating a bio-molecular mechanism that is able to account for the keratoconus, and explaining the latter through a Simpler theory though robust and explicit is may be difficult to accept. But beyond these considerations, it is certain that the most important is the search for truth, and in the present case, this one is promising because it sketches the possibility of stopping and preventing the disease.

  22. Jim D says:

    Hello!
    I was diagnosed at the Rotschield Foundation two months ago. Following the consultation, I made a list of the situations that put my eyes "under pressure": the pillow (I sleep now with my glasses), the pool (I swapped the goggles for a mask) and when I have an irrepressible urge to rub me The eyes I put a drop of lubricant. I hope that these arrangements will be enough to stop the deformation process.
    On the other hand, I did not manage to have an appointment for lenses before November at Rotschield. Do you have any contacts to advise me in the city?
    Thanks BQ for your site. I read that of the Association keratoconus. NET just before with patient testimonials and they are not as reassuring... ^^

  23. Dr. Damien Gatinel says:

    I can not cite names of confreres but if you consult the association of the Keratoconus or the site of the Sfolc You should be able to find accessible practitioners within a reasonable time. The Contactology Department of the Rothschild Foundation will expand in the coming months to shorten these deadlines.

  24. Jeff L. says:

    Hello doctor,

    I made an appointment with you for July 10 after consulting "urgently" Dr. B. Because my eyesight has fallen and the keratoconus has evolved.

    I will try not to rub my eyes until then but after two days I find it very difficult, rubbing my eyes immensely.

    See you soon

    Kind regards

    Jeff L.

  25. Dr. Damien Gatinel says:

    It is very difficult to stop rubbing your eyes. This page provides tips for no more rubbing your eyes and thus to stop the evolution of the Keratoconus: https://defeatkeratoconus.com/eye-rubbing-tips/

  26. Michel says:

    Hello
    I have heard that between 30 and 40 years the disease no longer progresses and stabilizes is it true?
    Thanks for your response

  27. Dr. Damien Gatinel says:

    It's not true if patients with keratoconus continue to rub their eyes. In general, causes that have presided with the onset of eye rubbing tend to disappear or diminish in the quarantine (e.g. allergies). In addition, there are authentic case of keratoconus after the quarantine: https://defeatkeratoconus.com/portfolio-item/case-48/
    It is important to realise that keratoconus is not a genetic disease, but a response (deformation with biomechanical decompensation) to vigorous eye rubbing. Some traits specifically expose the occurrence of a permanent deformation in case of repeated frictions (fine and less resistant corneas). Somewhat like some skin phototypes more particularly exposed to sunburn after prolonged exposure to ultra violets, some "kératotypes" (particular types of cornea) are probably more vulnerable in case Friction.

  28. Lucas says:

    Hello

    I am 25 years old my name is Lucas.
    The Keratocône of my right eye would have evolved compared to 2016. The left not despite the fact that I scratch it also. Can the view be lowered without the result that it means that the cornea is maturing (degenerates)? Where is this intimately linked? The person I saw advice me the graft for the right eye where I have already been crosslinking. By dint of rubbing the eye, can the cornea tear suddenly? Because if I decide to wait until the next appointment in 6 months to see a possible stabilization (by the friction) I want to be aware of the risks I incur if my cornea is too refined.

    Thanks for reading me.
    Lucas

  29. Dr. Damien Gatinel says:

    If you don't rub your eyes, the keratoconus will be stable. This is not necessarily to say that you will feel that your vision is stable. In fact, visual fluctuations are common in case of keratoconus, even in topographically stable terms. When patients rub excessively, the cornea does not tear, but it is refined and some complications, such as Hydrops, (brutal and often painful edema) can occur.

  30. Vigier says:

    Hello
    My son is 17 years old, and is suffering from keratocône, and his sight has fallen sharply in 6mois.
    The ophthalmologist recommended a laser session only on one eye.
    He wears glasses because he is myopic and does not necessarily scratch his eyes, but spends time on the computer, can it be a cause?
    I get a lot of worries about the fate of his eyesight, we live near Montpellier and would like to have a second opinion with a specialist, can you give me a hand?
    Thank you

  31. Dr. Damien Gatinel says:

    There is no keratoconus without eye friction; This assertion may seem amazing to you, but it stems from extensive clinical experience and logical deductions that are explained on this site and elsewhere (www.defeatkeratoconus.com). Computer work is often responsible for chronic eye fatigue or even fatigue when it is contemporaneous with a stressful period (exams, studies, etc.) and all this contributes to the eye rubbing. It is crucial that your son becomes aware of this, because as long as he rubs, his KC may progress. On the other hand, our extensive and extended experience today shows that stopping friction helps to stop the evolution of the disease (and confirms the conjecture that the KC vector is primitively mechanical, since when one subtracts the to this type of traumtisme, there is no evolution). This is not necessarily the business of interventionist practitioners who often offer entry to the realization of a cross linking. This is useless because it is a bad answer to a bad indication. The cornea of KC patients is not primitively "softened" but rather "tendérisée" by friction (in general, it takes about 2 or 3 years of intensive frotttements for the keratoconus to manifest itself clinically). On the other hand, CXL induces a reduction in corneal sensitivity, and this often contributes to the shutdown or reduction of eye rubbing. But it is easier to stop rubbing spontaneously, because this saves to a cornea already traumatized mechanically to undergo a second chemical photo aggression.
    A often neglected aspect is that of the sleeping position, and it is necessary that your son, if he sleeps on the belly or the side, in support of an eye (or both alternating), tries to change his position of sleep. There are case where we think it is a bad sleep position with chronic eye irritation, which is at the origin of the Keratoconus, by the induction of vigorous and repeated morning frictions related to irritation Night eyepiece. The wearing of protective eye shells can inform about the possibility of nocturnal frictions and also be a way to protect (insulate) the eye.
    Finally, it is necessary to évidemement treat an allergy ocular if it exists concomittamment (everything to do in order to calm the eye itching).
    The KC is not a primitively genetic condition as may have been explained to you – myths are hard to live. The REACH is focal (local), this is well demonstrated today by sophisticated imaging techniques (Brillouin microscopy) and this focal character is perfectly logical since the frictions are usually exercised on a part (central or Lower paracentral) of the cornea. However, a terrain conducive to friction (atopic terrain) or a slightly finer than average cornea are traits that can have a genetic dimension.
    In conclusion, declare war on friction, and the distortion of the cornea will not evolve. A correction in glasses or lenses may be proposed.

  32. Bandlapalli Lee says:

    Hello doctor,

    My ophthalmologist diagnosed me with a binocular keratoconus last August.
    This diagnosis occurred about 1 month after the birth of my second child.
    I have since consulted 2 specialists of the cornea who advocate 2 strategies quite contradictory: one wishes to see me accept the implantation of rings intracornéens fairly quickly but is not opposed to the fact that I continue to breastfeed my baby until Six months. The second does not propose surgery but an increased monitoring of the potential evolution of the cones (option I have chosen). She advised me not to rub my eyes but also to put an end to breastfeeding immediately... I really care to breastfeed as long as possible and am a little baffled by these 2 approaches so different! I cannot find any information about the deleterious influence of breastfeeding on vision (hormonal impregnation causing edema in the eye?) that is why I am very interested in your opinion.
    On the other hand, I read above that a vitamin D3 supplementation is not indispensable but what about a possible collagen supplementation (marin?). Is it unrealistic to think that it could strengthen the structure of the cornea collagen?

    In advance, thank you for your answers!

    Pq: I am really relieved to learn that my children will be without doubt spared if they do not rub their eyes 😊

  33. Dr. Damien Gatinel says:

    In your situation it is quite possible to breastfeed. The most important thing is to stop rubbing your eyes, there is no point in trying to harden the cornea. Stopping the friction is enough to stop the evolution of the keratoconus.

  34. Anonymous says:

    Hello
    I have been diagnosed with a keratoconus recently, after reading your study, it is obvious that it has its logic.
    Indeed, since my very small sensitivity to light, dust, or other has caused me watery eyes all day long, conjunctivitis and above all filaments that make my daily painful, which follows obviously from irritation of The eye and therefore frictions in a very frequent way. A keratoconus diagnosed on the right eye only taking into account your comments regarding the links of friction and the progression of this disease, I was wondering (because reading that in 90% of case The progression reaches both eyes), if I could escape the transmission of this disease in the second eye?
    Thank you.

  35. Dr. Damien Gatinel says:

    If you no longer rub your eye unscathed (and you avoid pressing it at night), there is no risk of keratoconus on this side. It is by the way logically because you have little or no rubbing that eye that its cornea is not distorted? Obviously, it is also important to no longer rub the affected eye and possibly alter your sleep patterns (do not sleep "on" this eye).

  36. B says:

    Hello doctor,
    Thank you for all your contributions that are really of great help.
    I am 26 years old and have just diagnosed myself with a moderate keratoconus to the left eye (I get to reach 10/10 with glasses, although of course they do not remove the duplication down), right I have a shape fruste .
    I don't remember rubbing my eyes in adolescence. On the other hand, for 4-6 years I rub more or less regularly the eyes, especially at night (studies, computer) and in contact with allergens (which can explain that the disease manifests only now). I also have some specific memories: once a college teacher made me a note about my rubbing, thinking that I was bored in her class. Short. I had the chance to fall on your site and an ophthalmologist who immediately announced to me that the disease was related to eye rubbing . A check is scheduled for six months. I admit that it is quite stressful, but reading the case Reported on your site reassures me. I think I've read them all! I also try to change my sleep position so as not to press the eye.

    However my question is quite different. I was prescribed eye drops. A pharmacist advised me to put fingers at the corners of the eyes and exert a small pressure for 30-40 seconds after applying the drops. Can this method of application present a risk to the cornea as long as the pressure is exerted in the corner and not on the cornea itself?

    Well cordially and a big thank you,
    B

  37. Dr. Damien Gatinel says:

    Thank you for your comment and do not worry: the fact of having become aware and interrupted the frictions ocularies enough to stabilise the corneal distortion (it will unfortunately take time for this message to "pass" and get generalized, and it is Regrettable – That said I am pleasantly surprised that your ophthalmologist also relayed the information on friction and their causal role in the keratoconus). Néanmmoins, in your case , it is quite possible to exert pressure on the inner corner of the orbit. As you have understood, do not rub the eye itself. This manoeuvre is recommended to prevent eye drops from being hunted too early in the lacrimal pathways (where the manifold holes are located at the inner corners of the eyelids). What is deleterious to the cornea is the exercise of repeated pressures, such as when rubbing its eyes (the pressure exerted was estimated to be several kg per cm2 which is considerable, for a small dome made of interlaced collagen fibers, and of which The central thickness is in the order of half a millimetre...).

  38. Ajagemo says:

    Hello and thank you very much doctor for this valuable information. My son's hyperopic since he was a kid. The ophthalmologist consulted yesterday has a doubt and thinks he has a keratoconus. Topography planned for the month of August. He rubs his eyes.. If he stops these frictions does he have a chance that the topography is normal? Thank you

  39. Dr. Damien Gatinel says:

    I actually think that stopping the eye rubbing Alone is sufficient to prevent the onset of keratoconus. This assertion is supported by observation and deduction elements. It might be better to carry out the corneal topography before the month of August so that you can be fixed, but in all case , from here to the topography, and beyond, it is necessary to explain to your son that it is not necessary to rub vigorously and often the eyes, in order to avoid causing a biomechanical failure of the cornea.

  40. lb says:

    Hello!

    Following a routine check in a new ophta in January 2019, this one tells me a suspicion of KC (no correction allowed me to see perfectly). The suspicion is confirmed shortly thereafter by an orbscan: Fortunately it is for the moment a rather slight form ( keratoconus fruste )

    Indeed I have always rubbed my eyes a lot, since I was a child (I am 34 years old).

    Obviously, big worry at first. But following the reading of this site, I stopped radically to rub my eyes, and it happens that since my condition remained stable (confirmed by a 2nd orbscan recently, no evolution). I am corrected to 10/10 with glasses and it goes, even if it does not completely remove the downward deformation that one can observe on some elements (traffic lights at night etc... you have to get used to it). To follow, but I'm pretty optimistic.

    The announcement of the first diagnosis is a very difficult time, inevitably we worry a lot, so thank you for this site, which allows to give information, and especially the good advice to stabilize the evolution!

  41. Dr. Damien Gatinel says:

    I thank you for your testimony that perfectly illustrates the clinical reality of Keratoconus, " fruste "in your case . In fact, although this may seem "shocking", Keratoconus is not a genetic or hereditary disease, but a permanent deformation of the cornea linked to friction. Of course, some native corneal characteristics, like the thickness (very genetically determined), expose to a more or less rapid deformation for the same repetitive trauma. The friction stop leads directly to the stabilization of the deformation. Unfortunately, many patients in your situation do not receive information about it, and are directly oriented to surgeries such as cross linking, whose clinical efficacy is not really demonstrated (if CXL causes the friction stop, as often, then one can find it in this a small interest). Don't worry and share your experience with patients who may be affected by a "Keratoconus" fruste "or" beginner "(forums, etc.).

  42. The says:

    Hello doctor, already a big thank you for your site and all the info you broadcast. It is honorable to go against the major doctrines
    I got operated in March last 2018, very successful operation. I had a slight inflammation the first few days. I took all possible precautions: sunglasses for 6 months, no friction for 8 months almost etc.
    At 6 months I am declared 0.25 hyperopia and 0.75 astigmatism with both eyes. Before-2.5 and + 4 (big correction since the age of two years).
    However I am allergic during the months March April May. I unconsciously rubbed my eyes especially the right. I realize that my eyesight is less right side where I rubbed the most (when I close one eye for the other.
    I still see very well without glasses even at night to drive
    What do you think of that eye that lost sight? Without making an individual diagnosis I will be interested in your approach. I have an ophthalmic control soon and I asked again to see the surgeon
    In all case I will never rub my eyes again, thank you for your warnings. Without you I would not have known
    Good to you

  43. Dr. Damien Gatinel says:

    It is possible that the friction caused a slight deformation of the cornea, but without severe consequence on your vision, and if you have no longer rubbed since then, there will be no pejorative evolution. As (and even more so because the cornea is thin) for all patients, it is crucial to no longer rub your eyes after the realization of a refractive surgery.

  44. Sl says:

    Hello Dr and a big thank you for this info and research.
    I was 33 years old and was operated by LASIK more than three months ago and it went very well.
    I would like to put every chance on my side and prevent the health of my eyes to the Max, in order to avoid the possible development of a keratoconus or an ectasia, or other corneal embrittlement. My ophthalmo told me that you should not rub your eyes, eye operated or not.
    I have no history of Allergy and have no recollection of rubbing my eyes in my life.
    However, I have a question about washing the face, especially in the shower. Indeed, when reading these articles, I feel I have to relearn to wash my face, not to weaken the cornea. You never talk about it in your research. How to clean the eyelids in the shower? should we SOAP them? If so, does it not cause friction with the fingers? even delicate? If not, should we soaping around and never soaping the eyelids? I can't remember if I did it before the operation...
    Also, when the water jet is steered from the knob to the face, should the pressure be lowered? even though we have eyes closed? And also, to rinse the water on the eyelids after a shower or a face wash, are we not obliged to pass the pulp of the fingers on the eyelids, otherwise we have water that penetrates a little in the eyes? or it just has to blink several times of the eyes by having a strong chance to have a little water that enters the eye and stings the eyes.. is there a way to do better than another? I feel like I have to relearn to do some gestures that I did automatically before...
    I do not make up but overall, a makeup remover would also not correspond to a rubbing of the eyes?
    These are everyday gestures and I would like to get advice please.
    Thank you bcp

  45. Dr. Damien Gatinel says:

    The shower is an activity in which eye rubbing can occur: friction, repeated wiping manoeuvres. On the other hand, the water jet is not a danger. It is difficult to measure the forces involved in practice, but there is a considerable gap between the forces that patients apply by rubbing their eyes (about a dozen newtons) and those that represent the pressure of a fluid emitted by a shower knob. It is therefore important, after refractive surgery, not to rub the eyes with the hands, or a towel cloth, but to wipe them without excessive pressure. Remember that the most deleterious frictions are those that are exerted with the knuckles of the fingers, because these are hard, and they are in near direct contact with the corneal dome through the eyelids.

  46. Sl says:

    Thank you for these answers.
    What do you recommend for the treatment of LASIK eyelids for people who do not wear makeup?
    Can be wiped with a cotton soaked with micellar water or floral water of Blueberry e.g. (if there is better as a product I am gladly taker), delicately from top to bottom or from inside outward, regularly or daily?
    I find this method finally softer for the cornea than the soaping and rinsing with the fingers... What do you think?

  47. Samy says:

    Good evening doctor
    Thank you for your valuable advice
    It is true that keratoconus generally stabilizes between the ages of 32 and 40? In a natural way?
    What my ophthalmo I saw at 15 20 m explained to me also that it's not obvious that a keratoconus pushes so obvious
    Thank you

  48. Dr. Damien Gatinel says:

    Keratoconus stabilizes when you stop rubbing your eyes, or when you reach a point of balance between the mechanical stress caused and the shape of the cornea in response to the forces to which the natural state is subjected (i.e. the difference between intraocular and atmospheric pressure). This often happens after 30 years. The most important thing is never to exert repeated mechanical stress on your eyes again.

  49. Samy says:

    Hello doctor
    Thank you for your valuable advice
    I was diagnosed keratoconus 15 20
    Left eye stage 2,440 um cornea
    Right eye stage 1,450 um cornea
    I would like to know if all keratocones result has a transplant in all case ?

  50. Dr. Damien Gatinel says:

    Fortunately, only a small minority of keratoconus progress to transplantation. The future is actually in your hands, literally. Stopping friction is necessary and sufficient to stop the evolution of the deformation.

  51. Samy says:

    Hello doctor
    Thank you again for your advice and valuable support
    I stopped them strongly but I noticed a bisexual phenomenon
    Involuntary night rubbing during sleep and since I put in my head that it is absolutely necessary to stop all rubbing my brain wakes me up at night in the middle of rubbing action it is really bisard
    Which solution do you think should be chosen?
    Thank you so much

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