What treatment options are available?
It is important to minimise risks for further keratoconus progression. It is strongly suggested to ensure no eye rubbing and to manage any eye allergies so that there is no temptation to rub the eyes.
There is a surgical treatment that eye surgeons can also offer to slow and in some cases halt keratoconus progression when there is documented keratoconus progression (see corneal crosslinking below).
Treatment of Eye Allergies to stop eye rubbing
As eye rubbing and allergies are a risk factor for keratoconus, it is very important to avoid eye rubbing. However, when our eyes are irritated or itchy sometimes we may find ourselves rubbing our eyes by accident. To minimise any irritation on the front surface of the eye when there are signs of allergy, our optometrists may prescribe allergy-specific eye drops such as over the counter non-preserved Ketotifen (Zaditen) or prescription Olopatadeine (Patanol) eye drops, preservative-free lubricating drops and suggest using a cool compress. In some cases, prescription drops such as steroid eye drops may be necessary to reduce more severe or more prolonged allergy reactions. During your eye examination, your optometrist will look along your eyelids and the front surface of the eye and recommend the best anti-allergy plan for your eyes.
Strong eye rubbing in keratoconus has been strongly associated with risk of a serious eye condition called corneal hydrops. (1) This condition causes sudden decrease in vision, pain and discomfort with bright lights. (1) It is due to a rupture in the layers of the cornea with fluid leakage. (1) Most cases are managed by monitoring for 2-3 months, but in some cases surgery is required, particularly for improved vision. (1) Avoiding eye rubbing is important to reduce risk of corneal hydrops.
Treatment to Slow Keratoconus Progression – Corneal Crosslinking
If there are progressive changes in your eye shape, prescription or decreased vision due to keratoconus, our optometrists will discuss seeing a corneal ophthalmologist (eye surgeon) for discussion of corneal crosslinking. This procedure strengthens the tissue at the front of the eye to slow or stop the keratoconus from getting worse.
This is particularly important, as there can be more significant vision and eye health concerns with more severe levels of keratoconus. In particular, it may reduce the risk of requiring a corneal transplant which is a surgical procedure done in severe levels of keratoconus.
Corneal cross-linking involves Riboflavin (Vitamin B) eye drops to the cornea, activated by ultraviolet light. Depending on the thickness of the cornea, your ophthalmologist will discuss whether epithelium on or off is more appropriate. The procedure has been shown to stabilize keratoconus in 70-90% of people. It can also be done in combination with vision correction options such as intracorneal rings. For more information on this procedure see https://www.keratoconus.org.au/treatments/corneal-collagen-crosslinking/
A referral from an optometrist is required to see a corneal ophthalmologist for this procedure.
(1) Maharana PK, Sharma N, Vajpayee RB. Acute corneal hydrops in keratoconus. Indian J Ophthalmol. 2013;61(8):461-4.
Natalie Buckman is a clinical optometrist, educator, professional leader and ophthalmic medicines prescriber, who enjoys exploring the world and hitting the dance floor in her spare time.