Dr. Pattnaik's Laser Eye Institute New Delhi

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Inherent pathology of thinning of Cornea

Keratoconus is a degenerative disorder of the cornea, in which the cornea thins and bulges outward like a cone, resulting in distorted vision & may lead to irreversible corneal damage.

Keratoconus Symptoms

The earliest signs of keratoconus are usually blurred vision and frequent changes in eye glass prescription, or vision that cannot be corrected with glasses. Symptoms of keratoconus generally begin in late teenage years or early twenties, but can start at any time.Other symptoms include:

  • Increased light sensitivity
  • Difficultly driving at night
  • A halo around lights and ghosting (especially at night)
  • Eye strain
  • Headaches and general eye pain
  • Eye irritation, excessive eye rubbing

Keratoconus, especially in the early stages can be difficult to diagnose and all of the above symptoms could be associated with other eye problems. Simply recognizing symptoms does not by itself diagnose keratoconus.

Keratoconus requires a diagnosis from a competent eye doctor trained not only in recognizing the symptoms but also observing signs of keratoconus through direct measurement as well as inspection of the cornea at a microscopic level using a slit lamp.

Keratoconus Diagnosis & Treatment

Keratoconus can usually be diagnosed with a slit-lamp examination. The classic signs of keratoconus that the doctor will see when examining your eyes include:

  • Corneal thinning
  • Fleischer’s ring (an iron colored ring surrounding the cone)
  • Vogt’s striae (stress lines caused by corneal thinning)
  • Apical scarring (scarring at the apex of the cone)
  • The doctor will also measure the curvature of the cornea. This is done by:

  • Keratometry: an instrument that shines a pattern of light onto the cornea. The shape of the
    reflection of the pattern tells the doctor how the eye is curved.
  • Corneal topography: a computerized instrument that make three-dimensional “maps” of the
A typical corneal topography map looks like this:

Corneal topography has facilitated the diagnosis of keratoconus, helping establish the diagnosis earlier, follow progression more accurately and differentiate keratoconus from other conditions.


The time taken to perfrom C3R procedure is 30- 45 minutes. In this procedure, custom-made riboflavin eye drops are applied to the cornea, activated by ultraviolet light. C3R procedure causes the collagen fibrils to thicken, stiffen, and crosslink & reattach to each other, making the cornea stronger and more stable & stopping the progression of Keratoconus disorder. This is recommended when Keratoconus corneal changes are observed. Therefore, one need to consult Keratoconus Specialist regularly.
Once the C3R procedure is done, surgeon places a soft bandage contact lens on cornea and antibiotics are prescribed. The contact lens can be put off after one or two days.
The cornea increases in rigidity soon after the procedure although the process of cross-linking continues on for a period of a few days afterwards. The effect on corneal shape takes longer but flattening does not occur in all eyes that have had treatment. A satisfactory result will be arresting the progress of keratoconus.

Advantages of C3R

  • Simple non invasive procedure
  • Stop the progression of Keratoconus and causes some regression
  • No handling of lenses every day
  • No stitches
  • No incisions
  • Fast recovery

Using INTRALASE LASER Technology, Surgeon inserts INTACS -a thin semi-circular rings into the mid layer of keratoconus cornea. It flattens the cornea by changing the shape and location of the cone, improving the vision.


Although only 15-20% of those with keratoconus ultimately require corneal transplant surgery, for those who do, it is a crucial and sometimes frightening decision. However, those who know what to expect before, during and after surgery are better prepared and feel more in control of their health care.In keratoconus, a corneal transplant is warranted when the cornea becomes dangerously thin or when sufficient visual acuity to meet the individual’s needs can no longer be achieved by contact lenses due to steepening of the cornea, scaring or lens intolerance. Lens intolerance occurs when the steepened, irregular cornea can no longer be fitted with a contact lens, or the patient cannot tolerate the lens.