International Journal of Keratoconus and Ectatic Corneal Diseases

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VOLUME 7 , ISSUE 1 ( 2018 ) > List of Articles


Challenging the “No Rub, No Cone” Keratoconus Conjecture

Damien Gatinel

Keywords : Ectasia, Eye rubbing, Keratoconus.

Citation Information : Gatinel D. Challenging the “No Rub, No Cone” Keratoconus Conjecture. Int J Kerat Ect Cor Dis 2018; 7 (1):66-81.

DOI: 10.5005/jp-journals-10025-1161

License: CC BY-SA 3.0

Published Online: 01-09-2010

Copyright Statement:  Copyright © 2018; The Author(s).


Eye rubbing has long been acknowledged as a risk factor for keratoconus (KC), but its role in the pathogenesis of KC may not have been accorded sufficient prominence. This article puts forth the conjecture that KC is not a dystrophy of unknown genetics and biomolecular substratum, but rather a syndrome caused by eye rubbing, i.e., what has been called “keratoconus” is the direct consequence of mechanical trauma to the cornea by chronic and incessant eye rubbing, resulting in the progressive deformation and thinning of the corneal wall, the hallmarks of the disease. The conjecture is challenged in this article to investigate its compatibility with what is currently known about KC. The conjecture does not contradict previous clinical or experimental findings about KC, all of which can be interpreted in light of this proposed mechanism. Rather, it is a synthetic approach that incorporates the results of previous genetic and biochemical perspectives for understanding the pathophysiology of KC. In fact, this mechanical disease proposition would appear more compatible with explaining the variability of KC expression between patients, between eyes, and the predominance of sporadic cases. As such, eye rubbing may not be solely a risk factor as often coined in medical literature, but the direct cause of the syndrome labeled “keratoconus.” In conclusion, this mechanical theory provides a better explanatory framework for what is currently known about KC and confirms the validity of the “no rub, no cone” conjecture.

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