Skip to main content
Top
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology 11/2020

Open Access 01-11-2020 | Cornea

Incorrect sleeping position and eye rubbing in patients with unilateral or highly asymmetric keratoconus: a case-control study

Authors: Adrien Mazharian, Christophe Panthier, Romain Courtin, Camille Jung, Radhika Rampat, Alain Saad, Damien Gatinel

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 11/2020

Login to get access

Abstract

Purpose

To evaluate eye rubbing and sleeping position in patients with Unilateral or Highly Asymmetric Keratoconus (UHAKC).

Methods

Case-control study of consecutive UHAKC patients diagnosed at the Rothschild Foundation. Controls were age- and sex-matched, randomly selected refractive surgery clinic patients. Patients self-administered questionnaires regarding their family history of keratoconus, eye rubbing, and sleeping habits. All the eyes underwent a comprehensive ocular examination. Logistic regression was used to analyze univariate and multivariate data to identify risk factors for keratoconus.

Results

Thirty-three UHAKC patients and 64 controls were included. Univariate analyses showed that daytime eye rubbing [OR = 172.78], in the morning [OR = 24.3], or in eyes with the steepest keratometry [OR = 21.7] were significantly different between groups. Allergy [OR = 2.94], red eyes in the morning [OR = 6.36], and sleeping on stomach/sides [OR = 14.31] or on the same side as the steepest keratometry [OR = 94.72] were also significantly different. The multivariate model also showed statistical significance for most factors including daytime eye rubbing [OR = 134.96], in the morning [OR = 24.86], in the steepest eye [OR = 27.56], and sleeping on stomach/sides [OR = 65.02] or on the steepest side [OR = 144.02]. A univariate analysis in UHAKC group, comparing the worse and better eye, showed that eye rubbing [OR = 162.14] and sleeping position [OR = 99.74] were significantly (p < 0.001) associated with the worse eye.

Conclusion

Our data suggests that vigorous eye rubbing and incorrect sleeping position are associated with UHAKC. This is especially true in rubbing the most afflicted eye, and contributory sleep position, including positions placing pressure on the eye with the steepest keratometry.
Appendix
Available only for authorised users
Literature
1.
go back to reference Gordon-Shaag A, Millodot M, Shneor E (2012) The epidemiology and etiology of keratoconus. Int J Keratoconus Ectatic Corneal Dis 1(1):7–15CrossRef Gordon-Shaag A, Millodot M, Shneor E (2012) The epidemiology and etiology of keratoconus. Int J Keratoconus Ectatic Corneal Dis 1(1):7–15CrossRef
2.
go back to reference Holland DR, Maeda N, Hannush SB et al (1997) Unilateral keratoconus. Incidence and quantitative topographic analysis. Ophthalmology 104:1409–1413CrossRef Holland DR, Maeda N, Hannush SB et al (1997) Unilateral keratoconus. Incidence and quantitative topographic analysis. Ophthalmology 104:1409–1413CrossRef
3.
go back to reference Kennedy RH, Bourne WM, Dyer JA (1986) A 48-year clinical and epidemiological study of keratoconus. Am J Ophthalmol 101:267–273CrossRef Kennedy RH, Bourne WM, Dyer JA (1986) A 48-year clinical and epidemiological study of keratoconus. Am J Ophthalmol 101:267–273CrossRef
4.
go back to reference Gordon-Shaag A, Millodot M, Essa M et al (2013) Is consanguinity a risk factor for keratoconus? Optom Vis Sci 90:448–454CrossRef Gordon-Shaag A, Millodot M, Essa M et al (2013) Is consanguinity a risk factor for keratoconus? Optom Vis Sci 90:448–454CrossRef
5.
go back to reference Edwards M, McGhee CN, Dean S (2001) The genetics of keratoconus. Clin Exp Ophthalmol 6:345–351CrossRef Edwards M, McGhee CN, Dean S (2001) The genetics of keratoconus. Clin Exp Ophthalmol 6:345–351CrossRef
6.
go back to reference Wang Y, Rabinowitz YS, Rotter JI et al (2000) Genetic epidemiological study of keratoconus: evidence for major gene determination. Am J Med Genet 93:403–409CrossRef Wang Y, Rabinowitz YS, Rotter JI et al (2000) Genetic epidemiological study of keratoconus: evidence for major gene determination. Am J Med Genet 93:403–409CrossRef
7.
go back to reference Rahi A, Davies P, Ruben M et al (1977) Keratoconus and coexisting atopic disease. Br J Ophthalmol 61:761–764CrossRef Rahi A, Davies P, Ruben M et al (1977) Keratoconus and coexisting atopic disease. Br J Ophthalmol 61:761–764CrossRef
9.
go back to reference Naderan M, Shoar S, Rezagholizadeh F et al (2015) Characteristics and associations of keratoconus patients. Cont Lens Anterior Eye 38:199–205CrossRef Naderan M, Shoar S, Rezagholizadeh F et al (2015) Characteristics and associations of keratoconus patients. Cont Lens Anterior Eye 38:199–205CrossRef
10.
go back to reference Bawazeer A, Hodge W, Lorimer B (2000) Atopy and keratoconus: a multivariate analysis. Br J Ophthalmol 84:834–836CrossRef Bawazeer A, Hodge W, Lorimer B (2000) Atopy and keratoconus: a multivariate analysis. Br J Ophthalmol 84:834–836CrossRef
11.
go back to reference Kaldawy RM, Wagner J, Ching S et al (2002) Evidence of apoptotic cell death in keratoconus. Cornea. 2:206–209CrossRef Kaldawy RM, Wagner J, Ching S et al (2002) Evidence of apoptotic cell death in keratoconus. Cornea. 2:206–209CrossRef
12.
go back to reference McMonnies CW, Boneham GC (2003) Keratoconus, allergy, itch, eye rubbing and hand-dominance. Clin Exp Optom 86:376–384CrossRef McMonnies CW, Boneham GC (2003) Keratoconus, allergy, itch, eye rubbing and hand-dominance. Clin Exp Optom 86:376–384CrossRef
13.
go back to reference Bral N, Termote K (2017) Unilateral keratoconus after chronic eye rubbing by the nondominant hand. Case Rep Ophthalmol 8:558–561CrossRef Bral N, Termote K (2017) Unilateral keratoconus after chronic eye rubbing by the nondominant hand. Case Rep Ophthalmol 8:558–561CrossRef
14.
go back to reference Gomes JAP, Tan D, Rapuano CJ et al (2015) Global consensus on keratoconus and ectatic diseases. Cornea. 34:359–369CrossRef Gomes JAP, Tan D, Rapuano CJ et al (2015) Global consensus on keratoconus and ectatic diseases. Cornea. 34:359–369CrossRef
15.
go back to reference Saidel MA, Paik JY, Garcia C et al (2012) Prevalence of sleep apnea syndrome and high-risk characteristics among keratoconus patients. Cornea. 31:600CrossRef Saidel MA, Paik JY, Garcia C et al (2012) Prevalence of sleep apnea syndrome and high-risk characteristics among keratoconus patients. Cornea. 31:600CrossRef
16.
go back to reference Pedrotti E, Demasi CL, Fasolo A et al (2018) Obstructive sleep apnea assessed by overnight polysomnography in patients with keratoconus. Cornea. 37(4):470–473CrossRef Pedrotti E, Demasi CL, Fasolo A et al (2018) Obstructive sleep apnea assessed by overnight polysomnography in patients with keratoconus. Cornea. 37(4):470–473CrossRef
17.
go back to reference West SD, Turnbull C (2016) Eye disorders associated with obstructive sleep apnoea. Curr Opin Pulm Med 22(6):595–601CrossRef West SD, Turnbull C (2016) Eye disorders associated with obstructive sleep apnoea. Curr Opin Pulm Med 22(6):595–601CrossRef
18.
go back to reference Naderan M, Rezagholizadeh F, Zolfaghari M et al (2015) Association between the prevalence of obstructive sleep apnoea and the severity of keratoconus. Br J Ophthalmol 99(12):1675–1679CrossRef Naderan M, Rezagholizadeh F, Zolfaghari M et al (2015) Association between the prevalence of obstructive sleep apnoea and the severity of keratoconus. Br J Ophthalmol 99(12):1675–1679CrossRef
19.
go back to reference Gupta PK, Stinnett SS, Carlson AN (2012) Prevalence of sleep apnea in patients with keratoconus. Cornea. 31(6):595–599CrossRef Gupta PK, Stinnett SS, Carlson AN (2012) Prevalence of sleep apnea in patients with keratoconus. Cornea. 31(6):595–599CrossRef
20.
go back to reference Pihlblad MS, Schaefer DP (2013) Eyelid laxity, obesity, and obstructive sleep apnea in keratoconus. Cornea. 32(9):1232–1236CrossRef Pihlblad MS, Schaefer DP (2013) Eyelid laxity, obesity, and obstructive sleep apnea in keratoconus. Cornea. 32(9):1232–1236CrossRef
21.
go back to reference Kymionis GD, Grentzelos MA, Liakopoulos DA et al (2014) Corneal collagen crosslinking failure in a patient with floppy eyelid syndrome. J Cataract Refract Surg 40(9):1558–1560CrossRef Kymionis GD, Grentzelos MA, Liakopoulos DA et al (2014) Corneal collagen crosslinking failure in a patient with floppy eyelid syndrome. J Cataract Refract Surg 40(9):1558–1560CrossRef
22.
go back to reference Correia FF, Ramos I, Lopes B et al (2012) Topometric and tomographic indices for the diagnosis of keratoconus. Int J Keratoconus Ectatic Corneal Dis. 1:92–99CrossRef Correia FF, Ramos I, Lopes B et al (2012) Topometric and tomographic indices for the diagnosis of keratoconus. Int J Keratoconus Ectatic Corneal Dis. 1:92–99CrossRef
23.
go back to reference Saad A, Gatinel D (2016) Combining placido and corneal wavefront data for the detection of forme fruste keratoconus. J Refract Surg 32(8):510–516CrossRef Saad A, Gatinel D (2016) Combining placido and corneal wavefront data for the detection of forme fruste keratoconus. J Refract Surg 32(8):510–516CrossRef
24.
go back to reference Belin MW, Villavicencio OF, Ambrosio R Jr (2014) Tomographic parameters for the detection of keratoconus: suggestions for screening and treatment parameters. Eye Contact Lens 40:326–330CrossRef Belin MW, Villavicencio OF, Ambrosio R Jr (2014) Tomographic parameters for the detection of keratoconus: suggestions for screening and treatment parameters. Eye Contact Lens 40:326–330CrossRef
25.
go back to reference Imbornoni LM, Padmanabhan P, Belin MW et al (2017) Long-term tomographic evaluation of unilateral keratoconus. Cornea. 36(11):1316–1324CrossRef Imbornoni LM, Padmanabhan P, Belin MW et al (2017) Long-term tomographic evaluation of unilateral keratoconus. Cornea. 36(11):1316–1324CrossRef
26.
go back to reference Gordon-Shaag A, Millodot M, Kaiserman I et al (2015) Risk factors for keratoconus in Israel: a case-control study. Ophthalmic Physiol Opt 35(6):673–681CrossRef Gordon-Shaag A, Millodot M, Kaiserman I et al (2015) Risk factors for keratoconus in Israel: a case-control study. Ophthalmic Physiol Opt 35(6):673–681CrossRef
27.
go back to reference Mashor RS, Kumar NL, Ritenour RJ et al (2011) Keratoconus caused by eye rubbing in patients with Tourette syndrome. Can J Ophthalmol 46:83–86CrossRef Mashor RS, Kumar NL, Ritenour RJ et al (2011) Keratoconus caused by eye rubbing in patients with Tourette syndrome. Can J Ophthalmol 46:83–86CrossRef
28.
go back to reference Weed KH, MacEwen CJ, Giles T et al (2008) The Dundee University Scottish Keratoconus study: demographics, corneal signs, associated diseases, and eye rubbing. Eye (Lond). 22:534–541CrossRef Weed KH, MacEwen CJ, Giles T et al (2008) The Dundee University Scottish Keratoconus study: demographics, corneal signs, associated diseases, and eye rubbing. Eye (Lond). 22:534–541CrossRef
29.
go back to reference Owens H, Gamble G (2003) A profile of keratoconus in New Zealand. Cornea 22:122–125CrossRef Owens H, Gamble G (2003) A profile of keratoconus in New Zealand. Cornea 22:122–125CrossRef
31.
go back to reference Ezra DG, Beaconsfield M, Sira M et al (2010) The associations of floppy eyelid syndrome: a case control study. Ophthalmology. 117:831–838CrossRef Ezra DG, Beaconsfield M, Sira M et al (2010) The associations of floppy eyelid syndrome: a case control study. Ophthalmology. 117:831–838CrossRef
32.
go back to reference Ebihara N, Funaki T, Matsuda H et al (2008) Corneal abnormalities in the NC/Nga mouse. An atopic dermatitis model. Cornea 27:923–992CrossRef Ebihara N, Funaki T, Matsuda H et al (2008) Corneal abnormalities in the NC/Nga mouse. An atopic dermatitis model. Cornea 27:923–992CrossRef
33.
go back to reference Moran S, Gomez L, Zuber K, Gatinel D (2020) A case-control study of keratoconus risk factors. Cornea 39(6):697–701 Moran S, Gomez L, Zuber K, Gatinel D (2020) A case-control study of keratoconus risk factors. Cornea 39(6):697–701
34.
go back to reference Davidson AE, Hayes S, Hardcastle AJ et al (2014) The pathogenesis of keratoconus. Eye (Lond) 28:189–195 Davidson AE, Hayes S, Hardcastle AJ et al (2014) The pathogenesis of keratoconus. Eye (Lond) 28:189–195
35.
go back to reference Krachmer JH (2004) Eye rubbing can cause keratoconus. Cornea 6:539–540 Krachmer JH (2004) Eye rubbing can cause keratoconus. Cornea 6:539–540
36.
go back to reference Korb DR, Leahy CD, Greiner JV (1991) Prevalence and characteristics of eye-rubbing for keratoconic and non-keratoconic subjects. Invest Ophthalmol Vis Sci 32:1057 Korb DR, Leahy CD, Greiner JV (1991) Prevalence and characteristics of eye-rubbing for keratoconic and non-keratoconic subjects. Invest Ophthalmol Vis Sci 32:1057
37.
go back to reference Gatinel D (2016) Eye rubbing, a sine qua non for keratoconus? Int J Keratoconus Ectatic Corneal Dis 5:6–12 Gatinel D (2016) Eye rubbing, a sine qua non for keratoconus? Int J Keratoconus Ectatic Corneal Dis 5:6–12
38.
go back to reference Coyle JT (1984) Keratoconus and eye rubbing. Am J Ophthalmol 97:527–528 Coyle JT (1984) Keratoconus and eye rubbing. Am J Ophthalmol 97:527–528
39.
go back to reference Lindsay RG, Bruce AS, Gutteridge IF (2000) Keratoconus associated with continual eye rubbing due to punctal agenesis. Cornea 19:567–569 Lindsay RG, Bruce AS, Gutteridge IF (2000) Keratoconus associated with continual eye rubbing due to punctal agenesis. Cornea 19:567–569
40.
go back to reference McMonnies CW (2009) Mechanisms of rubbing-related corneal trauma in keratoconus. Cornea 28:607–615 McMonnies CW (2009) Mechanisms of rubbing-related corneal trauma in keratoconus. Cornea 28:607–615
41.
go back to reference Norouzpour A, Mehdizadeh A (2012) A novel insight into keratoconus: mechanical fatigue of the cornea. Med Hypothesis Discov Innov Ophthalmol 1:14–17 Norouzpour A, Mehdizadeh A (2012) A novel insight into keratoconus: mechanical fatigue of the cornea. Med Hypothesis Discov Innov Ophthalmol 1:14–17
42.
go back to reference Wilson SE, He YG, Weng J et al (1996) Epithelial injury induces keratocyte apoptosis: hypothesized role for the interleukin-1 (IL-1) system in the modulation of corneal tissue organization. Exp Eye Res 62:325–338 Wilson SE, He YG, Weng J et al (1996) Epithelial injury induces keratocyte apoptosis: hypothesized role for the interleukin-1 (IL-1) system in the modulation of corneal tissue organization. Exp Eye Res 62:325–338
43.
go back to reference Collier SA (2001) Is the corneal degradation in keratoconus caused by matrix metalloproteinases? Clin Exp Ophthalmol 29:340–344 Collier SA (2001) Is the corneal degradation in keratoconus caused by matrix metalloproteinases? Clin Exp Ophthalmol 29:340–344
44.
go back to reference Mackiewicz Z, Maatta M, Stenman M et al (2006) Collagenolytic proteinases in keratoconus. Cornea 25:603–610 Mackiewicz Z, Maatta M, Stenman M et al (2006) Collagenolytic proteinases in keratoconus. Cornea 25:603–610
45.
go back to reference Matthews FJ, Cook SD, Majid MA et al (2007) Changes in the balance of the tissue inhibitor of matrix metalloproteinases (TIMPs)-1 and -3 may promote keratocyte apoptosis in keratoconus. Exp Eye Res 84:1125–1134 Matthews FJ, Cook SD, Majid MA et al (2007) Changes in the balance of the tissue inhibitor of matrix metalloproteinases (TIMPs)-1 and -3 may promote keratocyte apoptosis in keratoconus. Exp Eye Res 84:1125–1134
46.
go back to reference Shneor E, Millodot M, Gordon-Shaag A et al (2014) Prevalence of keratoconus among young Arabs students in Israel. Int J Keratoconus Ectatic Corneal Dis 3:9–14 Shneor E, Millodot M, Gordon-Shaag A et al (2014) Prevalence of keratoconus among young Arabs students in Israel. Int J Keratoconus Ectatic Corneal Dis 3:9–14
47.
go back to reference Waked N, Fayad AM, Fadlallah A et al (2012) Keratoconus screening in a Lebanese students’ population. J Fr Ophtalmol 35:23–29 Waked N, Fayad AM, Fadlallah A et al (2012) Keratoconus screening in a Lebanese students’ population. J Fr Ophtalmol 35:23–29
48.
go back to reference Assiri AA, Yousuf BI, Quantock AJ et al (2005) Incidence and severity of keratoconus in Asir province. Saudi Arabia Br J Ophthalmol 89:1403–1406 Assiri AA, Yousuf BI, Quantock AJ et al (2005) Incidence and severity of keratoconus in Asir province. Saudi Arabia Br J Ophthalmol 89:1403–1406
49.
go back to reference Rabinowitz YS (2003) The genetics of keratoconus. Ophthalmol Clin North Am 16:607Y20 Rabinowitz YS (2003) The genetics of keratoconus. Ophthalmol Clin North Am 16:607Y20
50.
go back to reference Lee LR, Hirst LW, Readshaw G (1995) Clinical detection of unilateral keratoconus. Aust N Z J Ophthalmol 23:129–133 Lee LR, Hirst LW, Readshaw G (1995) Clinical detection of unilateral keratoconus. Aust N Z J Ophthalmol 23:129–133
51.
go back to reference Ambrosio R, Caiado AL, Guerra FP et al (2011) Novel pachymetric parameters based on corneal tomography for diagnosing keratoconus. J Refract Surg 27:753–758 Ambrosio R, Caiado AL, Guerra FP et al (2011) Novel pachymetric parameters based on corneal tomography for diagnosing keratoconus. J Refract Surg 27:753–758
52.
go back to reference Kanellopoulos AJ, Asimellis G (2013) Keratoconus diagnosis and progression classification based on evaluation of corneal asymmetry indices, derived from Scheimpflug imaging in keratoconic and suspect cases. Clin Ophthalmol 7:1539–1548 Kanellopoulos AJ, Asimellis G (2013) Keratoconus diagnosis and progression classification based on evaluation of corneal asymmetry indices, derived from Scheimpflug imaging in keratoconic and suspect cases. Clin Ophthalmol 7:1539–1548
53.
go back to reference Gritz DC, McDonnell PJ (1988) Keratoconus and ocular massage. Am J Ophthalmol 106:757–758 Gritz DC, McDonnell PJ (1988) Keratoconus and ocular massage. Am J Ophthalmol 106:757–758
54.
go back to reference Fakhraie G, Vahedian Z (2016) Post filtering surgery globe massage-induced keratoconus in an eye with iridocorneal endothelial syndrome: a case report and literature brief review. J Ophthalmic Vis Res 11:319–322 Fakhraie G, Vahedian Z (2016) Post filtering surgery globe massage-induced keratoconus in an eye with iridocorneal endothelial syndrome: a case report and literature brief review. J Ophthalmic Vis Res 11:319–322
55.
go back to reference Ioannidis AS, Speedwell L, Nischal KK (2005) Unilateral keratoconus in a child with chronic and persistent eye rubbing. Am J Ophthalmol 139:356–357 Ioannidis AS, Speedwell L, Nischal KK (2005) Unilateral keratoconus in a child with chronic and persistent eye rubbing. Am J Ophthalmol 139:356–357
56.
go back to reference Jafri B, Lichter H, Stulting RD (2004) Asymmetric keratoconus attributed to eye rubbing. Cornea 23:560–564 Jafri B, Lichter H, Stulting RD (2004) Asymmetric keratoconus attributed to eye rubbing. Cornea 23:560–564
Metadata
Title
Incorrect sleeping position and eye rubbing in patients with unilateral or highly asymmetric keratoconus: a case-control study
Authors
Adrien Mazharian
Christophe Panthier
Romain Courtin
Camille Jung
Radhika Rampat
Alain Saad
Damien Gatinel
Publication date
01-11-2020
Publisher
Springer Berlin Heidelberg
Published in
Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 11/2020
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI
https://doi.org/10.1007/s00417-020-04771-z

Other articles of this Issue 11/2020

Graefe's Archive for Clinical and Experimental Ophthalmology 11/2020 Go to the issue