Managing a middle-aged patient with bilateral neglected keratoconus: A rare case report

The Orbscan's benefits include providing a thickness map and being noncontact for keratoconus screening. However, several developing countries have delayed keratoconus management due to a lack of resources and qualified examiners. Here we report a case of underdiagnosed and mistreated by high astigmatism, leading to a neglected case of keratoconus. A 34-year-old woman is bothered by her developing blurred eyesight and habit of scratching her eyes. The streak retinoscopy examination revealed the right eye was 5/20 cc S+7.75 C-6.00 Axis 150 became 5/15 and 5/20 cc S+7.25 C-6.00 Axis 80 became 5/15 for the left eye. The Placido test revealed irregular lines. The Schirmer test showed dry eyes. Slit-lamp examination revealed irregular thin cornea, Munson sign, Rizzuti's sign, and Vogt's striae were positive. The manual keratometer showed remarkably high corneal powers. The corneal topography showed characteristics of keratoconus. Scleral contacts with AS-OCT guiding were inserted into both eyes. Each eye's final BCVA improved to 5/12 and 5/6.5, respectively. The patient attained better visual performance and comfort. Detecting keratoconus by corneal topography and scleral contact lens fitting improved visual acuity. A skillful practitioner and accessible sources are essential to prevent these neglected cases