Corneal Topography Parameters and Tear Film Break-up Characteristics in Keratoconus Patients

Aims/Background Previous studies have found that keratoconus (KC) patients are highly susceptible to dry eye disease (DED); however, the specific relationship between KC and DED has not been thoroughly investigated. This study aims to investigate the corneal topography parameters and tear film (TF) break-up characteristics in KC patients with and without DED. Methods This cross-sectional, single-masked study consisted of 44 KC patients (44 eyes; KC group) and 31 normal individuals (31 eyes; control group). All the participants were recruited from the Department of Ophthalmology and Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University (Shanghai, China) from February 2018 to January 2023. They underwent a routine ophthalmic examination, ocular surface disease index questionnaire, corneal fluorescein staining, and Schirmer I test. Additionally, the participants were examined using the Oculus Keratograph® (OCULUS Inc., Arlington, TX, USA) to determine their corneal topography, noninvasive TF break-up time, and TF break-up point. The KC patients were further divided into KC-DED and KC-non-DED subgroups to analyze the impact of KC on TF characteristics and the incidence of DED. Finally, the relationship between the TF break-up point and the maximum cornea curvature quadrant was investigated. Results In the KC group, 21 patients (21 eyes; 47.72%) were diagnosed with DED. The KC-DED and KC-non-DED subgroups exhibited significantly different maximum keratometry (Kmax, p = 0.021), index of surface variance (p = 0.048), and index of height decentration (p = 0.011) values. The logistic model showed a strong correlation between KC-DED incidence and Kmax value (odds ratio = 1.169, 95% confidence interval: 1.020-1.340, p = 0.025). Moreover, the occurrence of DED increased from 36.67% to 71.43% when the Kmax was >52.00 D (χ² = 4.623, p = 0.031). Furthermore, TF was more prone to break-up in the maximum corneal curvature quadrant in the KC group than in the control group (p < 0.001). Conclusion TF should be closely monitored in KC patients, as they are highly prone to DED incidence (Kmax >52.00 D) and experience initial TF break-up in the maximum corneal curvature quadrant.