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Eye rubbing pattern can give clues about keratoconus

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KIAWAH ISLAND, S.C. — Excessive eye rubbing can contribute to progression of keratoconus, according to a specialist here.

Patients who have keratoconus have been mistaken for allergy patients due to their constant eye rubbing, Alan Carlson, MD, said at Kiawah Eye 2012.

“The old concept is that keratoconus patients are more likely to have allergies and, therefore, are more likely to rub their eyes because allergic patients rub their eyes,” Carlson said. “And we’ve kind of debunked that — showing that yes, they can have allergic eye disease. But even when they do, they have very distinct patterns.”

Keratoconus patients and allergy patients can be differentiated by their specific eye rubs.

“The keratoconus eye rub is in fact a cornea rub. It’s a pressure using usually the knuckle, the finger. It’s often a circular motion,” he said. “That rub is distinct from the eyelid rub or the conjunctival rub that the allergic patients have. It’s back and forth. They use the back of the hand, the fist.”

Physical signs of keratoconus rubbing include significant asymmetry and floppy eyelid syndrome on one side. Carlson said approaching patients about the rubbing and making them aware of these symptoms are important.

“When you ask patients about eye rubbing, one of the things you can do is not just say, ‘Do you rub your eyes?’ but ‘When do you like to rub your eyes?’” Carlson said. “It begins with us being aware of it. Most of the patients will deny it for a lot of reasons. Some of them just plain aren’t aware of it because it’s incorporated into their daily activity.”