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CA Ling, JY Choi, W Reinhart, RA Burnstine, AJ Locastro; Keratoconus and Acute Hydrops Associated with Thumb-Sucking Ritual . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3231.
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Purpose: We present an unusual case of unilateral keratoconus (KC) and acute hydrops in an 11- year-old patient who engaged in a unique ritual of thumb-sucking since age 5. She has no known associated conditions or risk factors for KC such as atopy, Down's syndrome, connective tissue disorders, Leber's congenital optic neuropathy, hard contact lens wear or hereditary predisposition. We demonstrate how a seemingly harmless and common habit of thumb-sucking can have potentially devastating consequences through induction and exacerbation of unilateral corneal changes consistent with keratoconus and acute hydrops in pediatric patients. Methods: Anterior segment ophthalmologic exam was performed including photographs and corneal topography measurements OU. Ocular, medical, social and family history were explored. Personal habits including thumb-sucking behavior were evaluated. Results: Unilateral KC and acute hydrops were seen in the right eye on which the patient applied digital pressure and massage while thumb-sucking. Anterior segment photos showed frank KC and acute hydrops, and corneal topography was consistent with irregular astigmatism of acute hydrops. External photos documented the patient with thumb in mouth and four fingers pressed onto the surface of her right upper lid with her hand in a grasping position. Four years prior the patient reportedly had 20/20 Va OU on her only previous eye examination and no obvious corneal abnormalities except for mild astigmatism requiring no correction. Whether this was the beginning of early keratoconus is indeterminate, as no corneal topographic readings were taken. During this time the patient began her unusual daily thumb-sucking ritual, emulating a newborn sibling's thumb-sucking, to aid her sleeping 8-10 hours/day . Conclusion: Individuals are known to suck their thumbs as a coping mechanism and out of habit to compensate for loss of nurturance, to relieve stress, and to even help them sleep. To the best of our knowledge, this is the first reported case of keratoconus and acute hydrops in a pediatric patient associated with thumb-sucking ritual. Though eye rubbing and ocular massage have been documented as major etiologic factors in adult keratoconic patients, this report documents that the simple habit of thumb-sucking in the pediatric population deserves ocular consideration as well.
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