Often the cause of keratoconus is unknown. Some studies have found that keratoconus runs in families, and that it happens more often in people with certain medical problems, including certain allergic conditions. Some think that chronic eye rubbing can cause keratoconus. But most often, there is no eye injury or disease that could explain why the eye starts to change.

Keratoconus usually begins in the teenage years, but it can also start in childhood or up to about age 30. The changes in the shape of the cornea usually occur slowly over several years.

Someone with keratoconus will notice that vision slowly becomes distorted. The change can stop at any time, or it can continue for several years. In most people who have keratoconus, both eyes are eventually affected, although not always to the same extent.

These factors can increase your chances of developing keratoconus: Certain diseases - The risk of developing keratoconus is higher if you have certain inherited diseases or genetic conditions, such as Down syndrome. Keratoconus also is more likely in people with allergies or asthma, connective tissue disorders and some retinal diseases. Family history of keratoconus.

Symptoms: Initial symptom is impaired vision (in one eye it is more than the fellow eye) due to irregular myopic astigmatism. This visual loss can only be improved by hard contact lenses. Later on there is further impairment of vision and contact lens can no longer correct the visual loss.

Signs:
1. Irregular retinoscopic reflex.
2. Distortion of mires of placido’s disc or of keratometer.
3. Vertical folds at the level of deep stroma and descemet,s membrane (Vogt’s sign).
4. Prominent corneal nerves.
5. Thinning of the central cornea with protrusion just below and nasal to the centre.
6. Munson,s sign – A ‘bulging’ or ‘tenting’ of the lowerlid when the patients looks down.
7. Fleischer’s Ring – Epithelial iron deposition at the base of the cone.

Tests to diagnose keratoconus include:

Eye Refraction- In this standard vision test, your eye doctor uses special equipment that measures your eyes to check for astigmatism and other vision problems. This may include a measurement taken by a computerized refractor, which automatically checks your eyes' focusing power, or by retinoscopy, a technique that evaluates light reflected by your retina. Then your eye doctor may ask you to look through a mask-like device that contains wheels of different lenses. This helps your doctor find the combination of lenses that gives you the sharpest vision.

Slit-lamp examination- This test shines a vertical beam of light on the surface of your eye while the eye doctor looks through a low-powered microscope to view the shape of your cornea. The test may be repeated after eye drops are used to dilate your pupils so that the doctor can view the back of your cornea.

Keratometry- A circle of light is focused on your cornea, and the reflection is used to evaluate your cornea's curvature.
Computerized corneal mapping- Optical scanning techniques, known as computerized corneal topography, can take a picture of your cornea and generate a topographical map of your eye's surface.

Treatment options for Keratoconus include;

• Spectacles
• Soft contact lenses
• Rigid gas permeable contact lenses (when fitted properly this is the most successful option)
• Hybrid contact lenses.
• Mini-scleral contact lenses
• Intacs with Riboflavin cross-linking C3R.
• Re-prescribing glasses, soft contact lenses or rigid gas permeable contact lenses after
• If corneal transplantation is finally required its success rate is greater than 95% when undertaken by an expert corneal surgeon. 40% of people having corneal transplants will require contact lenses again and the vast remaining number will require some form of spectacles. Unfortunately the reality is that many people with Keratoconus struggle to function in every-day life due to inappropriate treatment options or advice.

The surgical options of keratoconus include. Intrastromal corneal ring segments (ICRS). During this surgery, your doctor inserts small, synthetic arcs into your cornea to flatten your cornea's cone, support the cornea's shape and improve vision. First, you are given local anesthetics around your eye. Your surgeon makes an incision in your cornea, either with a precision blade or a laser, and inserts the two arcs in specific locations based on your cornea's shape. The incision is closed with stitches, and a soft lens is placed over your eye to protect it as it heals.

Although this surgery can restore a more normal corneal shape and halt the progression of keratoconus, many people still need to wear corrective lenses following the procedure. However, the surgery makes it easier to fit and tolerate contact lenses. Since the surgery is reversible, some people try ICRS before considering keratoplasty.

Keratoplasty. If you have corneal scarring or extreme thinning, you will need a corneal transplant, called keratoplasty, which can be performed in a number of ways. Intralamellar keratoplasty is a partial-thickness transplant, in which only a section of the cornea's surface is replaced. Penetrating keratoplasty is a full-cornea transplant, in which an entire portion of your cornea is replaced.

During a keratoplasty, you may have a general anesthetic, or just your eye may be numbed with a local anesthetic. Your doctor removes a button-shaped portion of your cornea, replacing it with a similar-sized button from a donor cornea. Stitches and a soft lens are placed to protect your eye as it heals. Recovery after keratoplasty can take up to one year, and you will likely continue to need rigid contact lenses to have clear vision.

Emerging treatments
A new treatment for keratoconus, called collagen cross-linking, is showing promise. After having riboflavin drops applied to your corneas, you receive 30 minutes of exposure to ultraviolet A (UVA) light. The procedure hardens and stabilizes the corneas, with the goal of preventing further thinning or bulging. The treatment is still in its testing phase and additional study is needed before it's widely available.

The course of the disorder can be quite variable, with some individuals, remaining stable for years or indefinitely, while others progress rapidly or experience occasional exacerbations over a long and otherwise steady course. Most commonly keratoconus progresses for a period of ten to twenty years before the course of the disease stabilizes in middle age.

In advanced keratoconus, your cornea may become scarred, particularly where the cone forms. A scarred cornea causes worsening vision problems and may require corneal transplant surgery. The effect of ongoing vision problems on your daily life can also lead to anxiety.

The course of the disorder can be quite variable, with some individuals, remaining stable for years or indefinitely, while others progress rapidly or experience occasional exacerbations over a long and otherwise steady course. Most commonly keratoconus progresses for a period of ten to twenty years before the course of the disease stabilizes in middle age.

The expense depends upon the grades of treatment.