Over the last three plus decades, I have developed a specialty of fitting Rigid Contact lenses for Keratoconus. Early in my practice, I was providing feedback for Art Optical, resulting in the development of their AKS fitting system. This would be what we now refer to as beta testing.

One thing KCN patients have in common is that they frequently and often subconsciously rub their eyes. Over the years I have wondered why it is possible for some individuals to be able to aggressively rub their eyes and not develop KCN, while others get it with very little rubbing. One of the ophthalmologists that I work with is constantly rubbing his eyes and yet he does not have any corneal changes.

After thorough investigation of the literature, I found no research involving this conundrum. I started to look at a pattern with all of the marines I examine here at Naval Hospital Camp Lejeune. There are a significant number of marines that have Keratoconus. In my first year of practice at NHCL, I treated more patients with KCN than in the previous 27 years of private practice in Vermont. They are under extraordinary physical stress in their duties and will get foreign bodies, dry eye, environmental allergies and other stimuli that cause aggressive eye rubbing. Those eye rubbers that acquire KCN have only one thing that differentiate them from non-keratoconus eye rubbers: 

They do not demonstrate Bell’s Phenomenon. 

As I investigated further into this discovery, I found that patients that have no Bell’s Phenomenon eventually demonstrate classic KCN topography of corneal steepening just below the visual axis. Those patients that just have minimal Bell’s Phenomenon eventually present with Pellucid’s Marginal Dystrophy. 

In this discovery of the reason for the selectivity of KCN development, I have decided to refer to it as the Begun Syndrome. The syndrome’s components are: eye rubbing, nonexistent or minimal Bell’s Phenomenon and keratoectasia. I don’t refer to lack of Bell’s Phenomenon as negative Bell’s Phenomenon because I have seen patients bell downward instead of up. That is what I would refer to as negative Bell’s Phenomenon. The concept of a familial predisposition for the development of KCN may not be the KCN itself, but the lack of the defensive action of Bell's phenomenon.

This of course is not based on scientific method evaluation. It would behoove the research departments of Optometry and Ophthalmology Colleges to do a formal study of this observation. Observe the lack of Bell's Phenomenon in KCN patients. To make the study objective, I would recommend that the measurement of Bell’s Phenomenon be done in a dark room using an infrared camera, such as found on the Sony Night Shot camcorder setting. This would eliminate any fixation stimuli by the subject.

It would also be wise to incorporate routine testing for Bell's Phenomenon on all patients as a prognosticator to possibly prevent future Keratoconus from developing.  In the case of a longevity study, selection of subjects would be easy for those that have Bell's Phenomenon. Finding non Bell's Phenomenon patients would be more difficult since they are fewer in number. It can be assumed that all subjects rub their eyes, since this is something most people do to some extent. Whether it be getting out of bed in the morning, getting shampoo in our eyes or a foreign body from dust in the wind, we all rub our eyes from time to time.