Keratoconus

Ectatic comdition of eye-
1. Keratoconus 
2. Keratoglobus (associated with blue sclera, Leber congenital amaurosis)
3. PMD (Pellucid Marginal Degeneration)

Keratoconus-
• Bilateral idiopathic (we don’t know cause) progressive ectasia of cornea 
• Cornea thin & conical 
• Most common in young female 
• Starts at puberty & progression is arrested in ~30 year.

Patient main complain: Frequent changes in glasses prescription, due to astigmatism (1st WTR then Irregular astigmatism)

Sign in keratoconus: 

• Oil droplet reflex

• Fleischer’s ring (Iron deposition in the corneal epithelium / Base (not apex) of cornea.

• Munson’s sign- When the patient looks downward, the inferior lid protrusion is a classic clinical sign of advanced keratoconus. It occurs due to the cone-shaped protrusion of the cornea.

• Rizutti’s sign
• Vogt striae 

• Applanation (Pulsating sign) - on tonometry (IOP measure)

• Nerve prominent- Corneal nerve prominent [PYQ: Rajasthan MO 2025]

• Scissor reflex (Normally horizontal & vertical lines seen)
• Hydrops - Acute increase in IOP Rapid reflux of fluid Corneal perforation

Diagnosis-
1. Placido disc: tell about anterior corneal curvature

2. Pentacam: (Colorful image)
• Tell everything about cornea
• Based on “Scheimpflug principle”
• Topography of cornea

Treatment-
1. Offer eye glasses: but it’s temporary 
2. Rigid gas permeable (RGP) contact lens

3. C3R (Corneal Collagen Cross-Linking with Riboflavin):
 - De epithelised the cornea

 - put riboflavin (Vitamin B6) and shown UV light for 30 minutes 

 - Increase cross linkage bond in corneal stroma
 - Increase corneal strength 

4. Intacs (Intra stromal corneal ring segments):
 - Made up of PMMA
 - Put into corneal stroma