Case Report: Importance of a full eye assessment

Daniel Moriarty
February 26, 2024
2 min read

Keratoconus is an eye condition which causes the cornea (front clear tissue of the eye) to gradually thin and become irregular. It induces irregular astigmatism which means that vision in spectacles or soft contact lenses are often reduced, requiring a rigid contact lens to provide improved vision. Keratoconus often presents in late teenage years or in the early twenties often causing a reduction in vision right in the middle of a person's prime social developmental years.

An interesting case I saw a couple of weeks ago was a 21-year-old male presented to the clinic for a scleral contact lens fitting. He had keratoconus in both eyes with a thin corneal thickness of 346 microns in the right eye and 397 microns in the left eye. His vision was reduced in his spectacles due to his irregular astigmatism, with an aided spectacle acuity of R6/12= and L6/20.

His eye pressures were at the higher side of the normal range at 19.7mmHg in the right eye and 19.7mmHg in the left eye. But given his thin corneas, his true eye pressures would be significantly higher approximately ~28mmHg in the right eye and ~26mmHg in the left eye.
After inserting a scleral contact lens to improve the view of the fundoscopy and OCT scans. Posterior eye assessment revealed large optic nerve cupping and an inferior temporal optic nerve thinning in the right optic nerve.

Retinal nerve fibre loss inferior
Figure 1: Inferior temporal retinal nerve fibre loss as seen on OCT

Visual fields revealed a corresponding right superior nasal peripheral field defect.

Glaucoma visual field loss
Figure 2: Superior nasal visual field loss corresponding to inferior temporal nerve fibre loss

While glaucoma is extremely rare in young people, it is important to thoroughly assess the back of the eye no matter the age of the patient and to remember that...

people with keratoconus also have a retina!

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