Corneal Ectasia: Key Facts from Causes to Treatments

Corneal ectasia is a progressive eye disorder where the cornea, the clear front surface of the eye, becomes thin and starts to bulge outward. This condition causes the following issues:

• Irregular Astigmatism: The cornea's uneven shape disrupts the eye's ability to focus light correctly, leading to blurred or distorted vision.
• Visual Impairment: As the cornea protrudes, vision can become increasingly impaired, making it difficult to perform daily tasks.
• Increased Light Sensitivity: Patients often experience heightened sensitivity to light, causing discomfort in bright environments.
• Structural Weakness: The cornea's structural integrity weakens, making it more susceptible to further damage or progression of the condition.

Corneal ectasia can develop due to a variety of factors, including:

• Genetic Predisposition: A family history of corneal ectasia or related conditions like keratoconus can increase the risk.
• Eye Rubbing: Frequent and vigorous rubbing of the eyes can damage the cornea and contribute to the development of ectasia.
• Pre-existing Corneal Conditions: Conditions such as keratoconus, where the cornea naturally thins and bulges, can lead to ectasia.
• Post-LASIK Surgery Complications: Some individuals may develop corneal ectasia following LASIK surgery, especially if the cornea was thin or structurally weak before the procedure. 

Post-LASIK corneal ectasia is a condition that occurs after LASIK eye surgery, where the cornea becomes progressively thinner and bulges outward. This condition is characterized by:

• Weakened Corneal Structure: LASIK surgery involves reshaping the cornea, which can sometimes weaken its structural integrity.
• Progressive Vision Changes: Patients may experience worsening vision after initially successful LASIK surgery.
• Increased Risk Factors: Individuals with pre-existing corneal conditions or thin corneas are at higher risk of developing ectasia post-surgery.
• Symptoms Similar to Ectasia: These include blurred vision, increased sensitivity to light, and frequent prescription changes.

Corneal ectasia presents with several symptoms that can affect daily life, including:

• Blurred or Distorted Vision: Progressive changes in the cornea's shape cause vision to become blurry or wavy.
• Frequent Changes in Prescription: Rapidly changing vision often necessitates frequent updates to glasses or contact lens prescriptions.
• Increased Sensitivity to Light (Photophobia): Bright lights can cause discomfort and difficulty seeing.
• Eye Strain and Fatigue: Constant effort to see clearly can lead to tired, strained eyes.
• Double Vision (Diplopia): Seeing two images of a single object can occur, making tasks like reading challenging.
• Halos and Glare: Bright lights at night, such as headlights, may cause halos or glare, making night driving difficult. 

Recognizing these symptoms early can lead to prompt diagnosis and treatment, helping to preserve vision and quality of life.

Diagnosing corneal ectasia involves several steps and tests performed by an eye care professional:

• Comprehensive Eye Examination: A thorough check of visual acuity and eye health.
• Corneal Topography: This imaging technique maps the surface curvature of the cornea, identifying irregularities.
• Pachymetry: Measuring corneal thickness helps detect thinning areas, a key indicator of ectasia.
• Slit-lamp Examination: This allows the doctor to closely inspect the cornea for any abnormalities.
• Keratometry: This test measures the cornea's curvature to detect steepening or bulging areas.
• Optical Coherence Tomography (OCT): Provides detailed cross-sectional images of the cornea to assess its structure. 

There are several treatment options available to manage corneal ectasia, including:

• Specialty Contact Lenses: Rigid gas-permeable or scleral lenses can help improve vision by providing a smooth refractive surface.
• Corneal Cross-Linking (CXL): According to WebMD, this procedure doesn't reverse existing corneal changes but prevents further deterioration.
• Intracorneal Ring Segments (ICRS): Small ring implants inserted into the cornea help reshape and stabilize it.
• Topography-Guided Custom Ablation: This laser treatment reshapes the cornea based on detailed topographical maps.
• Corneal Transplant: In advanced cases, a full or partial corneal transplant may be necessary to restore vision. In advanced cases, a full or partial corneal transplant may be necessary to restore vision. The AAO notes that rejection can occur in up to 30% of patients undergoing full-thickness transplants.
• Regular Monitoring: Frequent check-ups are essential to monitor the condition and adjust treatments as needed. 

Each treatment option aims to stabilize the cornea, improve vision, and prevent further deterioration. Consulting with an eye care specialist will help determine the best course of action for each case.