Keratoconus typically begins during the teenage years or early 20s and can progress into 30s before stabilising. It affects both eyes in most cases, though one eye is often more affected than the other.
At Pure Sight Eye Surgeons, we diagnose keratoconus using corneal topography,tomography, and epithelial mapping, These highly detailed assessments analyse the shape, curvature, and thickness of the cornea, which are essential for precise detection of even early or subclinical keratoconus that may not be identified with standard eye tests.
Causes and Risk Factors
The exact cause of keratoconus is not fully understood, but several factors are associated with its development:
- Genetics — keratoconus can run in families, though many people with the condition have no family history
- Eye rubbing — chronic, vigorous eye rubbing is one of the most significant modifiable risk factors. If you’ve been diagnosed with keratoconus, stopping eye rubbing is essential
- Allergies and atopic conditions — hay fever, eczema, and asthma are more common in people with keratoconus, possibly because these conditions increase the tendency to rub the eyes
- Connective tissue disorders — conditions that affect the structural proteins of the body may be associated
Symptoms
In the early stages, keratoconus may cause only mild blurring and irregular astigmatism that can be corrected with glasses. As the condition progresses, symptoms may include:
- Increasingly distorted or blurred vision, even with glasses
- Frequent changes in glasses prescription
- Sensitivity to light and glare
- Halos around lights
- Difficulty with night vision
- Ghosting or multiple images from a single object
Diagnosis
The diagnosis of keratoconus is determined by using corneal topography, corneal tomography, and epithelial mapping which create detailed maps of the corneal surface and thickness. These tools, along with early monitoring, can detect keratoconus at very early stages, before symptoms become apparent. This is one reason why corneal scanning is an important part of the assessment for anyone considering laser eye surgery, as keratoconus (even mild or subclinical forms) is a contraindication to most corneal laser procedures.
Treatment
The management of keratoconus is guided by two key principles: slowing or halting progression of the condition, and improving visual quality.
Stabilising the cornea is essential to prevent further thinning and shape distortion, particularly in patients with progressive keratoconus. Equally important is visual rehabilitation: enhancing the quality of vision through tailored treatment strategies based on the individual’s needs and stage of disease.
Corneal cross-linking (CXL)
Corneal cross-linking is a procedure designed to strengthen the cornea and slow or halt the progression of keratoconus. It involves applying riboflavin (vitamin B2) drops to the cornea and then exposing it to controlled ultraviolet light. This creates new bonds (cross-links) between the collagen fibres in the cornea, making it more structurally stable.
CXL doesn’t reverse existing distortion, but it can prevent further thinning and bulging. It’s most commonly recommended for patients with progressive keratoconus, particularly younger patients where the condition is more likely to worsen.
CAIRS (Corneal Allogenic Intrastromal Ring Segments)
CAIRS is an advanced surgical option used in selected patients to improve corneal shape and visual quality. Unlike synthetic ring segments, CAIRS utilises donor corneal tissue implanted within the cornea, providing a more natural and biologically integrated approach.
By flattening the cone and regularising the corneal surface, CAIRS can improve vision and may also contribute to enhanced biomechanical stability. This technique can reduce irregular astigmatism and is often combined with corneal cross-linking to both strengthen the cornea and optimise its optical performance.
CAIRS represents an additive and evolving approach in the management of keratoconus, particularly for patients seeking visual improvement beyond stabilisation alone.
Contact lenses
As keratoconus progresses, standard glasses often can’t adequately correct the irregular astigmatism. Specially designed contact lenses become the primary visual correction:
- Rigid gas-permeable (RGP) lenses create a smooth optical surface over the irregular cornea
- Scleral lenses are larger lenses that vault over the cornea entirely and rest on the white of the eye, providing excellent vision and comfort
- Hybrid lenses combine a rigid centre with a soft outer skirt
At Pure Sight Eye Surgeons, our focus is on the diagnosis, monitoring, and surgical management of keratoconus. Contact lens fitting is performed in collaboration with our trusted network of experienced optometrists, who specialise in complex contact lens care for keratoconus.
We work closely with these providers to ensure patients receive optimal visual outcomes alongside appropriate medical and surgical treatment.
Corneal transplant
In advanced keratoconus where contact lenses can no longer provide adequate vision or can’t be tolerated, a corneal transplant (keratoplasty) may be necessary. This involves replacing the damaged cornea with healthy donor tissue. Corneal transplant is a well-established procedure but is reserved for cases where other options have been exhausted.
Keratoconus and Refractive Surgery
Keratoconus is generally a contraindication to corneal laser eye surgery (LASIK, PRK, SMILE Pro), because these procedures involve thinning the cornea, which can worsen the condition. However, ICL surgery may be an option for some patients with stable keratoconus who want to reduce their dependence on contact lenses, as ICL doesn’t affect the cornea. Dr Chiu will assess your individual suitability.
Frequently Asked Questions
Can keratoconus be cured?
Keratoconus can’t be cured, but its progression can be slowed or halted with corneal cross-linking, sometimes combined with CAIRS and vision can be effectively managed with further surgical intervention such as ICL surgery, or non surgical options such as contact lenses. For most patients, these treatments provide good functional vision and prevent the need for a corneal transplant.
Will I go blind from keratoconus?
Keratoconus can significantly impair the vision, but rarely causes total blindness. With appropriate management, including cross-linking to stabilise the cornea and contact lenses for visual correction, most people with keratoconus maintain functional vision throughout their lives.
Can I have laser eye surgery if I have keratoconus?
Corneal laser procedures (LASIK, PRK, SMILE Pro) are not suitable for patients with keratoconus. Vision improvement can be achieved through CAIRS and ICL surgery, which may be an option for some patients with stable keratoconus. CAIRS regularises the cornea and ICL surgery doesn’t involve altering the cornea, and both procedures are additive, rather than taking any corneal tissue. For further regularisation a specific type of topographic guided PRK laser is sometimes used. A thorough assessment is needed to determine suitability.
Should I stop rubbing my eyes?
Yes. Eye rubbing is one of the strongest modifiable risk factors for keratoconus progression. If you have keratoconus or are at risk, you should avoid rubbing your eyes. If itchy eyes from allergies are causing the urge to rub, treating the allergies can help.