Risk factors for developing keratoconus: A review article

Authors

  • José Luis Santos Montes de Oca Universidad Autónoma de Tamaulipas. Facultad de Medicina de Tampico “Doctor Alberto Romo Caballero”
  • Francisco Vázquez Nava Universidad Autónoma de Tamaulipas. Facultad de Medicina de Tampico “Doctor Alberto Romo Caballero”

Keywords:

Keratoconus, Eye rubbing, Atopy, Risk factors, Corneal ectasia

Abstract

ABSTRACT:

Introduction: Keratoconus (KC) is a progressive corneal disease that mainly affects young adults, impairing vision and quality of life. Its timely detection is crucial because of its impact on public health.

Objective: To identify the main risk factors associated with the development of KC, based on recent scientific literature.

Method: Articles in English and Spanish published in the last five years in databases such as PubMed and ScienceDirect were reviewed. Observational studies and meta-analyses were included.

Results: Of 117 studies found, 10 met inclusion criteria. Ocular rubbing and atopy were the most consistent factors. Other factors such as UV exposure, contact lenses, sleeping position and contamination were also identified.

Conclusions: Detection of modifiable factors may reduce the progression of KC. It is essential to integrate them into clinical preventive strategies.

References

1. Debourdeau E, Planells G, Chamard C, Touboul D, Villain M, Demoly P, et al. New keratoconus risk factors: A cross-sectional case-control study. J Ophthalmol. 2022;6605771. doi: 10.1155/2022/6605771

2. Kandel H, Pesudovs K, Watson SL. Measurement of quality of life in keratoconus. Cornea. 2020;39(3):386-393. doi: 10.1097/ICO.0000000000002170

3. Keratoconus - EyeWiki [Internet]. 2024. [Citado 20 de marzo de 2025]. Disponible en: https://eyewiki.org/Keratoconus

4. Yam G.H.F., Riau A.K., Funderburgh M.L., Mehta J.S., Jhanji V. Keratocyte biology. Exp Eye Res. 2020;108062. doi: 10.1016/j.exer.2020.108062

5. Asimellis G, Kaufman EJ. Keratoconus [Internet]. StatPearls - NCBI Bookshelf. 2024. [Citado 22 de marzo de 2025]. Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK470435/

6. Lucas SEM, Burdon KP. Genetic and environmental risk factors for keratoconus. Annu Rev Vis Sci. 2020;6:25-46. doi:

7. Santodomingo-Rubido J, Carracedo G, Suzaki A, Villa-Collar C, Vincent SJ, Wolffsohn JS. Keratoconus: an updated review. Cont Lens Anterior. 2022;45(3):101559. doi: 10.1016/j.clae.2021.101559

8. Flockerzi E, Xanthopoulou K, Goebels SC, Zemova E, Razafimino S, Hamon L, et al. Keratoconus staging by decades: a baseline ABCD classification of 1000 patients in the Homburg Keratoconus Center. Br J Ophthalmol. 2021;105(8):1069-1075. doi: 10.1136/bjophthalmol-2020-316789

9. Hashemi H, Heydarian S, Hooshmand E, Saatchi M, Yekta A, Aghamirsalim M, et al. The prevalence and risk factors for keratoconus: A systematic review and meta-analysis. Cornea. 2020;39(2):263-270. doi: 10.1097/ICO.0000000000002150

10. Song M, Chen T, Moktar A, Chan E, Chong EW, Daniell M, et al. Diagnosis and management of keratoconus: A narrative review of clinicians' perspectives. Children (Basel). 2022;9(12):1973. doi: 10.3390/children9121973

11. Deshmukh R, Ong ZZ, Rampat R, Alió Del Barrio JL, Barua A, Ang M, et al. Management of keratoconus: an updated review. Front Med (Lausanne). 2023;10:1212314. doi: 10.3389/fmed.2023.1212314

12. Debourdeau E, Planells G, Chamard C, Touboul D, Villain M, Demoly P, et al. New keratoconus risk factors: a cross-sectional case-control study. J Ophthalmol. 2022:6605771. doi: 10.1155/2022/6605771

13. Guo X, Bian J, Yang K, Liu X, Sun Y, Liu M, et al. Eye rubbing in Chinese patients with keratoconus: A multicenter analysis. J Refract Surg. 2023;39(10):712-718. doi: 10.3928/1081597X-20230831-04

14. Yang K, Li D, Xu L, Pang C, Zhao D, Ren S. Independent and interactive effects of eye rubbing and atopy on keratoconus. Front Immunol. 2022;13:999435. doi: 10.3389/fimmu.2022.999435

15. Jurkiewicz T, Marty A.S. Correlation between Keratoconus and Pollution. Ophthalmic Epidemiol. 2021;28(6):495–501. doi: 10.1080/09286586.2021.1879173

16. Yang K, Gu Y, Xu L, Fan Q, Zhu M, Wang Q, et al. Distribution of pediatric keratoconus by different age and gender groups. Front Pediatr. 2022;18(10):937246. doi: 10.3389/fped.2022.937246

17. Crawford AZ, Zhang J, Gokul A, McGhee CNJ, Ormonde SE. The enigma of environmental factors in keratoconus. Asia Pac J Ophthalmol (Phila). 2020;9:549–556. doi: 10.1097/APO.0000000000000334

18. Ferrari G, Rama P. The keratoconus enigma: A review with emphasis on pathogenesis. The Ocular Surface. 2020;18(3):363-373. doi: doi.org/10.1016/j.jtos.2020.03.006

19. Moran S, Gomez L, Zuber K, Gatinel D. A case-control study of keratoconus risk factors. Cornea. 2020;39(6):697-701. doi: 10.1097/ICO.0000000000002283

20. Lo ACQ, Lo CCW. The association between keratoconus and the risk factors of eye rubbing, atopy and other allergic diseases (conjunctivitis, rhinitis, asthma and eczema): a meta-analysis. Int Ophthalmol. 2023;43(5):1451-1452. doi: 10.1007/s10792-022-02542-9

21. Seth I, Bulloch G, Vine M, Outmezguine J, Seth N, Every J, et al. The association between keratoconus and allergic eye diseases: a systematic review and meta-analysis. Clin Exp Ophthalmol. 2023; 51(4):01-016. doi: 10.1111/ceo.14215

22. Claessens JLJ, Godefrooij DA, Vink G, Frank LE, Wisse RPL. Nationwide epidemiological approach to identify associations between keratoconus and immune-mediated diseases. Br J Ophthalmol. 2022;106(10):1350:1354. doi: 10.1136/bjophthalmol-2021-318804

23. Weng SF, Jan RL, Wang JJ, Tseng SH, Chang YS. Association between atopic keratoconjunctivitis and the risk of keratoconus. Acta Ophthalmol. 2021;99(1):e54-e61. doi: 10.1111/aos.14509

24. Tello A, Navarro PA, Pedraza-Concha A, Villamizar SJ, Galvis V. Sleeping behavior and keratoconus: a scoping review. Cesk Slov Oftalmol. 2025;81(Ahead of print):1-10. doi: 10.31348/2025/6

25. Song M, Fang QY, Seth I, Baird PN, Daniell MD, Sahebjada S. Non-genetic risk factors for keratoconus. Clin Exp Optom. 2023;106(4):362-372. doi: 10.1080/08164622.2022.2062222

Published

2026-10-15

How to Cite

Santos Montes de Oca, J. L., & Vázquez Nava , F. (2026). Risk factors for developing keratoconus: A review article. Archivos De Medicina, Salud Y Educación Médica, 5(1). Retrieved from https://archivosdemedicina.uat.edu.mx/index.php/nuevo/article/view/104

Issue

Section

Artículos
Received 2026-08-07
Accepted 2026-09-21
Published 2026-10-15