Chronic Ocular Inflammation and Keratoconus

  • Igor Kaiserman
  • Sara Sella


Keratoconus (KC) has conventionally been held to be a non-inflammatory progressive thinning of the cornea affected by genetic and environmental factors leading to irregular astigmatism and impairment of visual function. KC is know to be associated with atopy, vernal keratoconjunctivitis, retinitis pigmentosa, eye rubbing, Down syndrome, and connective tissue disorders.

In recent years, evidences are amounting that inflammatory factors might play a role in KC pathogenesis and progression. Tears from patients with the disease have been found to have elevated levels of pro-inflammatory cytokines such as: interleukin(IL)-6, tumor necrosis factor -α and matrix metalloproteinase-9, as well as accumulation of cytotoxic by products from the nitric oxide and lipid peroxidation pathways, abnormal antioxidant enzymes, and increased levels of mitochondrial DNA damage. Increased binding of IL-1 by corneal fibroblasts might also suggest a role for inflammation in the onset or progression of keratoconus.

Because dry eyes in general and blepharitis in particular were also found to be associated with KC, the potential relationship between KC and dry eye is under investigation. Chronic high levels of pro-inflammatory factors or intense eye rubbing due to itching might be the missing link between KC and blepharitis. Treating blepharitis with eyelid heating and iatrogenic ocular massage might also exacerbate KC.

Although RGP contact lenses are a must in many KC patients the lenses might also have a negative impact on the disease by inducing a state of chronic ocular surface inflammation and dry eyes or by mechanically rubbing the cornea and inducing repeated micro-trauma.


Keratoconus Ocular inflammation Dry eyes Blepharitis Matrix metalloproteinases Eye rubbing 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Igor Kaiserman
    • 1
  • Sara Sella
    • 2
  1. 1.Department of Ophthalmology, Barzilai University Medical Center, Ashkelon, Faculty of Health ScienceBen Gurion University of the NagevBeer-ShebaIsrael
  2. 2.Department of OphthalmologyMeir Medical CenterKefar-SabaIsrael

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