Contributor: Jesse Vislisel, MD
Photographer: Stefani Karakas, CRA
Keratoconus is a bilateral corneal ectasia characterized by central thinning and bulging of the cornea resulting in a cone-shaped protrusion. This patient demonstrates multiple characteristic signs of the condition. The top photo demonstrates central Vogt's striae, or parallel, vertical lines from posterior stromal stress. A Fleischer ring, or epithelial iron deposition around the base of the cone is visible superiorly. The horizontally-oriented opacities are areas of stromal scarring. The second photograph utilizes a slit beam to show the paracentral cone with associated stromal thinning. The third photograph shows more significant apical scarring in the contralateral eye. The bottom photograph shows protrusion of the bottom eyelid is downgaze due to the cone-shaped cornea.
Contributor: William Charles Caccamise, Sr, MD, Retired Clinical Assistant Professor of Ophthalmology, University of Rochester School of Medicine and Dentistry
*Dr. Caccamise has very generously shared his images of patients taken while operating during the "eye season" in rural India as well as those from his private practice during the 1960's and 1970's. Many of his images are significant for their historical perspective and for techniques and conditions seen in settings in undeveloped areas.
The photo shows scarring of the cornea at the apex of the keratoconus.
This female patient demonstrated the typical findings with keratoconus: There was conical ectasia (bulging) with an irregular myopic astigmatism. Keratoconus is sometimes called ectatic corneal dystrophy. 70% of the cases occur in females.
Munson's sign in left eye
Keratoconus is present in both eyes. However, Munson's sign (bowing of the lower lid upon downgaze) is apparent in left eye only.
Ophthalmic Atlas Images by EyeRounds.org, The University of Iowa are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.