Treatments and drugs

By Mayo Clinic Staff

Treatment for keratoconus depends on the severity of your condition and how quickly the condition is progressing.

Mild to moderate keratoconus can be treated with eyeglasses or contact lenses. For most people, the cornea will become stable after a few years. You often won't experience severe vision problems and require further treatment.

In some people with keratoconus, however, the cornea becomes scarred or wearing contact lenses becomes difficult. In these cases, surgery might be necessary.

Lenses

For most people with keratoconus, contact lenses are the most effective treatment.

  • Eyeglasses or soft contact lenses. Glasses or soft contact lenses can correct blurry or distorted vision in early keratoconus. But people frequently need to change their prescription for eyeglasses or contacts as the shape of their corneas change.
  • Rigid gas permeable contact lenses. Hard (rigid gas permeable) contact lenses are often the next step in treating progressing keratoconus. Rigid lenses may feel uncomfortable at first, but many people adjust to wearing them. Rigid gas permeable lenses can be made to fit your corneas.
  • Piggyback lenses. If rigid lenses are uncomfortable, your doctor may recommend "piggybacking" a hard contact lens on top of a soft one. Fitting a combination of lenses takes a lot of precision, so be sure you work with a doctor experienced with this technique.
  • Hybrid lenses. These contact lenses have a rigid center with a softer ring around the outside for increased comfort. People who can't tolerate hard contact lenses may prefer hybrid lenses.
  • Scleral contact lenses. These lenses are useful for irregular changes in your cornea and advanced keratoconus. Instead of resting on the cornea like traditional lenses do, scleral contacts sit on the white part of the eye (sclera) and go over the cornea without touching it.

If you're using rigid or scleral contact lenses, make sure to have them fitted by an eye doctor with experience in treating keratoconus. You'll also need to have regular checkups and refittings because a poor-fitting hard contact lens can damage your cornea.

Surgery

You may need surgery if you have corneal scarring, extreme thinning of your cornea, poor vision with the strongest prescription lenses, or if you can't wear any type of contact lenses. Several surgeries are available, depending on the location of the bulging cone and the severity of your condition. Surgical options include:

  • Corneal inserts (intracorneal ring segments). During this surgery, your doctor inserts two tiny, clear, crescent-shaped plastic inserts into your cornea to flatten the cone, support the cornea's shape and improve vision.

    Corneal inserts can restore a more normal corneal shape, slow progress of keratoconus and reduce the need for cornea transplant. The surgery also makes it easier to fit and tolerate contact lenses. The corneal inserts can be removed, so the procedure can be considered a temporary measure.

    However, the surgery carries risks, such as infection and injury to areas of the eye during surgery.
  • Cornea transplant (keratoplasty). If you have corneal scarring or extreme thinning, you'll likely need a cornea transplant (keratoplasty).

    Lamellar keratoplasty is a partial-thickness transplant, in which only a section of the cornea's surface is replaced.

    Penetrating keratoplasty, the most common cornea transplant, is a full-cornea transplant. In this procedure, doctors remove an entire portion of your cornea and replace it with donor tissue.

    A deep anterior lamellar keratoplasty (DALK) preserves the inner layer of the cornea (endothelium). It helps avoid rejection caused by the endothelial cells in a full-thickness transplant.

    Recovery after keratoplasty can take up to one year, and you may need to continue to wear rigid contact lenses to have clear vision. Full improvement of vision may occur several years after your transplant.

    Cornea transplant generally is very successful, but possible complications include graft rejection, poor vision, astigmatism, inability to wear contact lenses and infection.

Emerging treatment

A new treatment called collagen cross-linking shows promise for people with keratoconus.

After having riboflavin drops applied to your cornea, you're exposed to ultraviolet A (UVA) light. The procedure strengthens the cornea to prevent further thinning or bulging. The treatment is still in the testing phase in the United States, and additional study is needed before it becomes widely available.

Feb. 20, 2013