What is Keratoconus?
The cornea is normally dome-shaped and smooth. In keratoconus (from the Greek keras - cornea, and konos - cone), the cornea progressively thins and bulges outward into a cone shape. This distorts the way light enters the eye, causing increasingly irregular vision that cannot be corrected with standard glasses.
Keratoconus typically begins in the teenage years or early twenties. It progresses over 10-20 years before usually stabilising in the mid-thirties. In some patients, it progresses quickly; in others, slowly. In rare cases, it can lead to a sudden painful episode called acute corneal hydrops - when the back layer of the cornea cracks, causing rapid vision loss that requires urgent treatment.
It is not an infection, not caused by rubbing your eyes alone, and not a cataract. It is a structural change in the cornea itself.
What Causes Keratoconus?
The precise cause is not fully understood, but several factors are consistently associated with the condition:
- Genetics: Keratoconus runs in families. If a parent or sibling has it, the risk is significantly higher.
- Eye rubbing: Chronic, vigorous rubbing - especially in patients with allergic eye disease - is strongly associated with progression. This is the most important modifiable risk factor.
- Atopy: Patients with eczema, asthma and allergic rhinitis (hay fever) have higher rates of keratoconus, likely related to eye rubbing.
- Connective tissue disorders: Conditions like Down syndrome, Marfan syndrome and Ehlers-Danlos syndrome carry higher keratoconus risk.
- Contact lens wear: Long-term hard contact lens use may accelerate corneal changes, though this is debated.
Symptoms: What Keratoconus Feels Like
The early stages of keratoconus are easily mistaken for ordinary short-sightedness. As it progresses, the symptoms become more distinctive:
- Vision that blurs and distorts, even with the strongest glasses
- Frequent changes in glasses prescription, especially with increasing astigmatism
- Seeing multiple images or ghost images around lights
- Glare and halos around lights, particularly at night
- Sensitivity to bright light
- A tendency to squint or tilt the head to see more clearly
- Glasses that no longer provide satisfactory vision even when newly prescribed
If you or a family member is experiencing any of these - particularly worsening vision despite current glasses - a cornea specialist assessment is the appropriate next step.
đź”— Cornea service at Eye One Centre: Cornea treatment and keratoconus management, Kangra
How Keratoconus is Diagnosed
The key diagnostic tool is corneal topography - a detailed map of the shape and thickness of the cornea. It detects the characteristic cone-shaped steepening before it is visible on a standard slit lamp examination. Eye One Centre, Kangra has corneal topography as part of its diagnostic capability.
A thorough examination will also include:
- Slit lamp biomicroscopy - to look for classical signs of keratoconus including Fleischer's ring and Vogt's striae
- Corneal pachymetry - measuring corneal thickness
- Refraction - to assess the degree of irregular astigmatism
- Best corrected visual acuity - how well vision can be corrected at all
Treatment Options for Keratoconus
Stage 1: Glasses and Soft Contact Lenses
In very early keratoconus, standard glasses and soft contact lenses may provide adequate vision. As the cone shape becomes more irregular, however, they stop correcting vision properly because they cannot compensate for an irregular surface.
Stage 2: Rigid Gas Permeable (RGP) Contact Lenses
RGP lenses vault over the irregular cornea and replace its surface with a smooth, regular optical surface. They remain the most widely used treatment for mild to moderate keratoconus and provide significantly better vision than glasses for most patients.
Scleral contact lenses - a larger version that rests on the white of the eye rather than the cornea - are particularly effective for advanced keratoconus and when the cornea is very sensitive.
Stage 3: Corneal Cross-Linking (CXL) - The Treatment That Stops Progression
Corneal cross-linking is the only treatment that addresses the underlying problem - it strengthens the cornea and halts or significantly slows the progression of keratoconus.
The procedure involves applying riboflavin (vitamin B2) drops to the cornea, then exposing it to controlled ultraviolet A light. This creates new molecular bonds between the collagen fibres of the cornea, making it stiffer and more resistant to further bulging.
CXL does not reverse existing distortion - it prevents further change. For this reason, the earlier it is performed, the more vision it protects. It is particularly important for younger patients with progressive keratoconus.
Stage 4: Intrastromal Corneal Ring Segments (ICRS)
Tiny crescent-shaped plastic rings (INTACS or Ferrara rings) are implanted within the corneal stroma to flatten and regularise the cone. They can improve both contact lens tolerance and sometimes uncorrected vision. They are often combined with cross-linking.
Stage 5: Corneal Transplant (Keratoplasty)
When the cornea has become too irregular or scarred for contact lenses to provide functional vision, corneal transplantation is the definitive treatment. Modern techniques including DALK (Deep Anterior Lamellar Keratoplasty) allow the central cornea to be replaced while preserving the patient's own healthy inner layers, resulting in better outcomes and lower rejection risk.
đź”— Cornea transplant surgery: Read our guide to cornea transplant surgery in Kangra
Keratoconus in Himachal Pradesh: Why Early Diagnosis Matters
In Kangra and across HP, keratoconus is regularly diagnosed late - often because patients have been managing with progressively stronger glasses for years without anyone suggesting a corneal examination. This is particularly common in young patients from rural areas who may not have access to specialist eye care.
The difference between early and late diagnosis is significant. Cross-linking performed early can preserve functional vision with contact lenses for decades. Late-presenting keratoconus with scarring may require transplantation.
Dr. Gitanjli Sood Sirkek - Chief Surgeon, Eye One Centre, Kangra
MBBS (IGMC Shimla) · MS Ophthalmology (Delhi University) · DNB · FMRF Vitreo-Retina (Sankara Nethralaya) · FAICO · FICO UK (Merit) · FRCG II Glasgow
15,000+ cataract surgeries · 5,000+ retinal procedures · 100+ publications · H-index 10 · Dr. MC Luthra Gold Medal 2022 · IJO Best Photograph Award 2024 & 2025
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At Eye One Centre, Kangra, keratoconus is assessed using corneal topography and managed with the full range of treatment options from contact lens fitting to surgical intervention. Dr. Gitanjli has FRCG II Glasgow - a qualification with specific emphasis on corneal and external disease.
Final Thoughts
Keratoconus is not a condition to fear. Detected early and managed correctly, most patients maintain good functional vision for their lifetime. The key is not to wait for glasses to stop working entirely before seeking a specialist opinion.
If you have been experiencing worsening vision despite changing your glasses prescription, or if you have been told you have high or irregular astigmatism, a corneal topography examination at Eye One Centre, Kangra will give you a clear answer within a single appointment.
Book a Keratoconus Assessment at Eye One Centre, Kangra
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