Keratoconus in a Case with Scleroderma: A Rare Coexistence

ABS TRACT A 50 year-old female admitted to the hospital with the complaint of decreased vision, burning and grittiness in her eyes. The diagnosis of scleroderma had been made by a rheumatologist seven years ago. On presentation, her best corrected visual acuity was 8/10 in the right eye and 5/10 in the left eye. Central corneal thickness measured by an ultrasonic pachymeter was 455 micrometer (μm) in the right eye and 423 μm in the left eye. Corneal topography showed bilateral central steepening consistent with diagnosis of keratoconus. Schirmer tear test (after topical local anesthetic) was 2 mm/5 minute bilaterally. Break-up time was 1 second bilaterally. Her physical features related to scleroderma included tightness of the skin, per-oral puckering and facial telangiectasia of her face as well as flexion contracture on her fingers. This is the first case report in the literature describing the association of keratoconus with scleroderma. Although scleroderma is usually associated with increased central corneal thickness, it can also rarely be associated with keratoconus like ectatic corneal disorders.