Corneal cross-linking for keratoconus caused by compulsive eye rubbing in patients with Tourette syndrome Three case reports

Rationale: Eye rubbing is an important risk factor for keratoconus progression. Tourette syndrome (TS) is a neurological disorder, and approximately 50% of individuals with TS exhibit obsessive-compulsive behaviors including eye rubbing. We report the effects of corneal cross-linking (CXL) on the progression of keratoconus combined with psychiatric treatment for 3 patients with TS. Patients' concerns: Three cases, 24-year-old male, 14-year-old male, and 17-year-old male, were all referred to our institute, due to decreased visual acuity. Diagnosis: All 3 patients were diagnosed with progressive keratoconus. They were found to rub their eyes, and were also diagnosed with TS by psychiatrists. Intervention: Upon diagnosis of keratoconus, we performed CXL on 1 eye of each patient. Outcomes: After CXL, there was no further progression. Psychiatric medication was also required. Lessons: For patients with keratoconus caused by eye rubbing due to TS, CXL seems to be effective when done in association with psychiatric treatment.