Keratoconus is one of the most important eye diseases for parents, teachers, coaches, and adults to understand because, if caught early, we now have the ability to help save vision and reduce the chance of future corneal transplantation. One of the most overlooked contributors to this disease is something many people do every single day without thinking about it: rubbing their eyes.
People often do not realize how much repetitive eye rubbing can damage the eye. When we rub our eyes, we are pushing on the eyeball and especially on the cornea, the clear front window of the eye that provides most of the eye’s focusing power. Over time, repeated pressure can weaken this delicate structure. For many people, rubbing begins innocently because their eyes itch from allergies, dryness, or irritation. Unfortunately, rubbing can become habitual. Patients often push harder and harder over time to achieve the same temporary feeling of relief, without realizing they may be harming their vision.
In some individuals, especially those genetically predisposed, repeated rubbing or pressure can contribute to the development or progression of keratoconus. Keratoconus occurs when the cornea becomes weakened and begins to thin and bulge outward into a cone-like shape. When this happens, light no longer focuses properly, leading to blurred vision, increasing astigmatism, glare, halos, ghosting, and progressive visual distortion. If left untreated, severe cases can eventually require corneal transplantation.
Eye rubbing is not the only source of pressure. We also see damage from what some doctors call “pillow diving,” where patients press their eye into a pillow while sleeping, particularly stomach sleepers or side sleepers. Sometimes we see one eye with very little astigmatism and the other eye with a large amount, and the patient will tell us that the worse eye is the one they constantly rub or sleep on against the pillow. Many patients later say, “I wish someone had warned me earlier.”
Children are especially important to watch because keratoconus often begins during the teenage years and can progress rapidly in younger patients. Parents may notice frequent eye rubbing, squinting, changing glasses prescriptions, headaches, or declining school performance related to vision. Kids with allergies are particularly at risk because itchy eyes drive the urge to rub. Treating allergies and dry eye disease early can help reduce this cycle.
That is why comprehensive eye examinations are so important. Modern corneal imaging called corneal topography allows eye doctors to map the shape of the cornea and detect early keratoconus, sometimes even before vision becomes severely affected. Detecting the disease early can be life changing.
One of the greatest advances in eye care has been corneal crosslinking. In this treatment, riboflavin (vitamin B2) eye drops and ultraviolet light are used to strengthen and stabilize the cornea. Crosslinking does not simply treat symptoms, it addresses the underlying weakness of the cornea itself. When performed early, especially in children and young adults, it can dramatically reduce progression and lessen the likelihood of needing a corneal transplant later in life.
It is very important to stop rubbing your eyes, treat the underlying causes of itching, and make sure children and adults at risk are screened for keratoconus. Early detection and modern treatments like crosslinking are helping preserve vision for an entire generation of patients.
Richard P. Holm, MD passed away in March 2020 after a battle with pancreatic cancer. He is founder of The Prairie Doc®. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook.
A Gregory, South Dakota native, Vance Thompson, MD is a Refractive, Corneal, and Cataract Surgeon in Sioux Falls, S.D.
