Assayag Elishai, Zadok David, Carmel Moshe, Abulafia Adi, Weill Yishay
Department of Ophthalmology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, ISR.
Cureus. 2024 Dec 19;16(12):e76013. doi: 10.7759/cureus.76013. eCollection 2024 Dec.
Keratoconus is a progressive corneal ectasia that may lead to severe visual impairment. Superior keratoconus (SK) is an uncommon form of the disease, and few cases have been reported thus far. We present an unusual SK case and a literature review of this rare diagnosis. A 49-year-old man presented to the ophthalmology clinic complaining of decreased vision in his right eye. Previous medical and ocular histories included medically treated attention-deficit hyperactivity disorder (ADHD) and keratoconus, which were diagnosed only in adulthood. A dense posterior subcapsular cataract was observed in the right eye. Corneal tomography revealed bilateral asymmetric SK, which was more severe in the right eye. The patient demonstrated unique eye-rubbing habits, which helped him cope with his ADHD symptoms and correlated with the keratoconus severity in each eye. In a literature review, 11 previously published cases of SK were summarized, none of which were associated with ADHD or included ipsilateral cataracts as in our patient. In conclusion, ADHD may cause repetitive eye rubbing and subsequent uncommon corneal ectatic changes, such as SK. Early recognition and characterization of eye rubbing can be crucial in detecting coexisting mental and ocular disorders.
圆锥角膜是一种进行性角膜扩张疾病，可导致严重视力损害。上角膜圆锥（SK）是该疾病的一种罕见形式，迄今为止报道的病例很少。我们报告一例不寻常的SK病例，并对这一罕见诊断进行文献综述。一名49岁男性到眼科门诊就诊，主诉右眼视力下降。既往病史和眼部病史包括药物治疗的注意力缺陷多动障碍（ADHD）和圆锥角膜，均在成年期才被诊断出来。右眼观察到致密的后囊下白内障。角膜地形图显示双侧不对称SK，右眼更为严重。患者表现出独特的揉眼习惯，这有助于他应对ADHD症状，且与每只眼睛的圆锥角膜严重程度相关。在文献综述中，总结了11例先前发表的SK病例，其中没有一例与ADHD相关，也没有像我们的患者那样包括同侧白内障。总之，ADHD可能导致反复揉眼及随后出现罕见的角膜扩张性改变，如SK。早期识别和明确揉眼情况对于发现并存的精神和眼部疾病可能至关重要。
