Risk factors for developing keratoconus: A review article
Keywords:
Keratoconus, Eye rubbing, Atopy, Risk factors, Corneal ectasiaAbstract
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
Downloads
Published
How to Cite
Issue
Section
License
ARCHIVOS DE MEDICINA,SALUD Y EDUCACIÓN MÉDICA by Universidad Autónoma de Tamaulipas is licensed under a Creative Commons Reconocimiento-CompartirIgual 4.0 Internacional License.
ARCIVOS DE MEDICINA, SALUD Y EDUCACIÓN MÉDICA es una revista digital de acceso abierto (OJS) y editada por la Universidad Autónoma de Tamaulipas, con publicación semestral Sitio web: ... Director de la revista:... Reserva de Derechos al Uso Exclusivo No..... otorgados por el Instituto Nacional del Derecho de Autor (INDAUTOR). Responsable de la última actualización Dr. José Alberto Ramírez de León, con domicilio en calle Matamoros S/N Zona Centro, C.P. 87000 Ciudad Victoria, Tamaulipas, México. Tels. (834) 3181800 y 3181700, ext 1148..
Accepted 2026-09-21
Published 2026-10-15

