Corneal epithelium in keratoconus

Specular microscopy was employed to study the corneal epithelium of 20 keratoconus patients (17 male, 3 female, average age 23.9 ± 6.6 years). The patients were divided into three groups based on the severity of the keratoconus: early, intermediate, and advanced. Initially, epithelial changes were limited to enlargement of the superficial cells. As the disease progressed, elongated cells became prominent. Irregularly configurated and nucleated epithelial cells were observed in all cases. Morphometric analysis showed that the mean area of the corneal epithelial cells was 906 ± 203 μm² in the early stage, 1,416 ± 521 μm² in the intermediate stage, and 1,641 ± 372 μm² in the advanced stage. The shape factor was 0.32 ± 0.05, 0.76 ± 0.22, and 0.81 ± 0.17, respectively. Controls were chronic wearers of hard contact lenses without corneal pathology. Analysis of their epithelium revealed no abnormalities. This finding suggests that the epithelial changes observed in keratoconus are not due to the wearing of contact lenses, but rather to the disease itself.