Keratoconus onset after age 50.

Area of Science:

• Ophthalmology
• Corneal Ectasia
• Refractive Surgery

Background:

• Keratoconus is typically diagnosed in younger individuals.
• Late-onset ectatic changes are uncommon, especially without prior ocular surgery or trauma.
• This case highlights a rare presentation of adult-onset keratoconus.

Observation:

• A 51-year-old woman with a history of stable mild astigmatism developed significant, rapid-onset astigmatism.
• Ocular examination revealed definite keratoconus in the left eye and possible keratoconus in the right eye.
• The patient had a history of soft contact lens wear and allergies but no eye rubbing or family history of keratoconus.

Findings:

• Topography and tomography confirmed keratoconus in the left eye and suggested it in the right eye.
• The patient's condition was treated with corneal collagen cross-linking (CXL).
• Early signs of clinical improvement were observed following CXL treatment.

Implications:

• Adult-onset keratoconus can occur unexpectedly, challenging typical diagnostic timelines.
• Corneal collagen cross-linking (CXL) may be an effective treatment option for late-onset keratoconus.
• This case underscores the importance of considering ectatic disorders even in older patients presenting with new-onset astigmatism.