Video showing the affects of eye rubbing on MRI
Keratoconus (KC) was first described in 1854 by Nottingham and has been described as being a non-inflammatory, bilateral, asymmetrical, progressive disorder characterized by ectasia, thinning, increased curvature of the cornea, and loss of visual acuity, especially with high irregular astigmatism
The prevalence of KC is estimated to be 1.38 per 1000 people and clustering significantly more in certain populations. Asian or Middle Eastern patients with KC are also younger at diagnosis and have more severe disease presentations, according to previous studies. The increased prevalence of KC in above average warmer, sunnier countries compared with those in Europe and North America has led to the theory that intense sunlight in these areas is a causative factor in genetically susceptible individuals.
However, the exact underlying cause of this illness is still unknown. Many possible mechanisms, include those of biochemical, genetic, and mechanical origin, have been examined, and a multifactorial origin is frequently mentioned. Environmental variables, including eye rubbing, atopy, and UV exposure, appear to be triggers for KC in genetically susceptible individuals. Ethnicity has a role as well, with Asians developing KC earlier and in a more aggressive form than in Caucasians. Furthermore, despite being visually asymptomatic, patients with a positive family history of KC have been demonstrated to exhibit early topographical changes suggestive of KC. Increased disease concordance has also been found in monozygotic twin and familial investigations.
Eye rubbing, a frequent behaviour that begins before sleep and lasts the entire day as a reaction to eye irritation, exhaustion, and emotional stress, is implicated as a significant exogenous environmental factor that induces a mechanical change in the cornea, often as the second hit in a double-hit hypothesis. Abnormal eye rubbing can occur subsequent to annoying symptoms, such as dryness and irritation . Atopy and allergies are the most prevalent risk factors for the persistent behaviour of inappropriate eye rubbing. According to several studies, KC and atopy are linked because pruritus increases eye rubbing, which causes corneal mechanical wear and progressive ectasia.
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![[Video] Adverse Eye Rubbing in Keratoconus](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4HRiK6MvFtia856foWYkBDP2bCVe0NB-S445VtbzLVYY19KJ6Pma-J-xabIQgjfE3RyTgr5C7Y9IvGs6PZ2ofcR13vtnGSwqghFJv40mZdjUD4VyOfjGN03Fhyphenhyphenziai2VNOASlDExTi77TdfDrh2yKeS735QlfIwwLZhn0xilsHeLiGDvhshth384ZzgBu/w72-h72-p-k-no-nu/keratoconus-pathogenesis.jpg)
