Ilateral Keratoconus Progression Following Anterior Levator Advancement Ptosis Surgery

To report a case of bilateral keratoconus after anterior levator advancement ptosis surgery.

Ophthalmology department, Hospital Sant Joan de Déu, Barcelona, Spain.

We present a clinical case report of bilateral progressive keratoconus following superior eyelid surgery along with computerized corneal topography images

A 10-year old with a medical history of allergies presented with progressive ptosis of her left eye for 3 years, ophthalmic examination showed frontalis hyperfunction and high eyelid crease. Best corrected visual acuity was 20/25 on both eyes with a prescription for low astigmatism and hypermetropia; a 2 year follow-up showed progressive ptosis on both eyes and stable prescription. An anterior levator aponeurosis advancement surgery was performed on both eyes, later the patient referred progressive bilateral blurred visión. An increased astigmatism and myopia shift in retinoscopy was documented; corneal topography showed irregular astigmatism, progressive increase of Kmax and posterior steepening. The patient was treated with Cross-Linking.

To our knowledge it is the first time keratoconus is reportedly developed following superior eyelid surgery, we consider it may be due firstly to changes in corneal shape after ptosis surgery or secondly to postoperative indication to massage the surgical wounds; although the patient  has a long history of eye rubbing and was being previously treated for that. Further studies are needed to associate  ptosis eyelid surgery to keratoconus in patients with chronic allergies.