Pseudokeratoconus in geleophysic dysplasia: a diagnostic pitfall

Keratoconus (KC) is a corneal ectasia associated with stromal thinning and biomechanical weakness which induces irregular astigmatism, progressive myopia and poor visual acuity. It is a multifactorial disease and may be associated with underlying ocular and systemic comorbidities. It is known that paediatric KC is aggressive and requires early intervention. Diagnosis relies on corneal topography demonstrating asymmetric steepening, infero-superior asymmetry and focal thinning. However, several conditions can mimic these tomographic features leading to misdiagnosis. Geleophysic dysplasia (GD) is one such rare skeletal dysplasia that may present with KC-like features on tomography. We report a case of a boy in early adolescence with GD misdiagnosed as KC and referred for bilateral corneal collagen cross-linking (CXL). Systemic examination and genetic testing confirmed GD type 1. This case highlights the importance of careful multimodal corneal evaluation in syndromic paediatric patients to avoid misdiagnosis and unnecessary interventions such as CXL.