Dr. Santosh Suman
+91 9624650880
0265-2370010 (10am to 08pm)


1. What is Keratoconus?
Keratoconus is the condition of the cornea, in which the cornea assumes a conical shape.

Model of Normal and Keratoconic eye

2. Is Keratoconus present from birth?
No, it usually manifests at the age of puberty and usually tends to progress (worsen) till the age of 30-35 years.

3. How do I suspect that I may have keratoconus?
If a patient has frequent change of glasses, he/she must be evaluated for keratoconus.

4. What are the tests to diagnose Keratoconus?
Ophthalmologists/ optometrists usually suspects keratoconus when abnormal ‘Scissoring reflex’ is seen on retinoscopy. Confirmation of keratoconus can be done by topography of cornea. Advance stages of keratoconus can be diagnosed on slit lamp itself. Also there are Pachymeteres which can measure the thickness of cornea at various zones of the cornea.

Corneal Topography showing Keratoconus

5. Are all Keratoconus cases progressive?
Keratoconus usually starts at the age of puberty and progresses till 30-35 years of age. If detected earlier, keratoconus usually has greater chance of progression. Nearing the age of 30 years, chance of progression is usually lesser.

6. What is “rupture of cornea” in keratoconus ?
In a small percentage of advance keratoconus cases, the inner layer of cornea gives way and fluid accumulates in the layers of cornea. This condition is known as “Acute Hydrops”.

Acute Hydrops

7. What is the Corneal Collagen Cross Linking (C3R/ CXL) ?
The cornea is largely composed of fibers which are called collagen. The collagen are interlinked with one other to give strength to the cornea and allow it to retain its shape. In Keratoconus, the cross linking between groups of collagen fibers is reduced, causing the cornea to stretch forward in response to the normal pressure from within the eye, thus worsening the cone. C3R procedure causes cross-linking among these collagen fibers and provide strength to the cornea.

Before- C3R



8. How Is C3R procedure done?
Topical anesthesia is applied. Outermost layer of cornea is scraped off. Then riboflavin drops are instilled onto the cornea surface for 30 minutes. Then the ultraviolet rays are focused onto the cornea, using a special UV lamp for 10 to 30 minutes. The eye can be bandaged or a bandage contact lens is applied at the end of the procedure.

However for the safety of this procedure, the corneal thickness has to be a minimum of 400 microns, to prevent UV damage to the innermost layer of the cornea (endothelium). Hence it cannot be done in advanced keratoconus, where the cornea is already considerably thinned out.

Some modifications in C3R are there for advance keratoconus where very thin cornea is swelled up (using hypotonic riboflavin/ saline drops) before C3R to prevent damage to endothelium.


9. What are the special contact lenses for Keratoconus ?
There are various options. Let your doctor decide which is best for you.

There are hard contact lenses. The other lenses are RGP (rigid-gas permeable) or ‘semi-soft’ contact lenses, which allow oxygen to enter the cornea through the lens. These are larger in size. Other option is ‘piggy-back’ lense, i.e. a soft contact lens, which is large and sits snugly over the conical cornea and is comfortable, over which you wear a hard or RGP lens, to improve vision.
There are special large lenses designed for Keratoconus, called “Rose K2 lenses”.The last option is the Scleral Lens, which is very expensive.

10.What is DALK in advance keratoconus?
If a patient has frequent change of glasses, he/she must be evaluated for keratoconus.

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