• Svetlana Stanojlovic, Milica Pejovic Milovancevic, and Branislav Stankovic.
• Faculty of Medicine, University of Belgrade.
• Medicine (Baltimore). 2020 May 29; 99 (22): e20247.

RationaleEye rubbing (ER) is a proven factor that can trigger the onset and progression of keratoconus (KC). Apart from allergy, ER is a repetitive motor stereotypy. Eye rubbing is frequently observed in children with autism spectrum disorders (ASDs) and in individuals who may be at risk for developing KC. We present a child with ASD who developed progressive KC following standard corneal cross-linking (CXL), most likely because of abnormal ER associated with allergy and repetitive behavior due to ASD symptoms.Patient ConcernsA 14-year-old boy was referred to our clinic because of asymmetric visual acuity reduction.DiagnosisThe child was diagnosed as having keratoconus. He had a strong ER habit. The child had been previously diagnosed as having ASD.InterventionsCorneal cross-linking was performed in both the eyes. On account of keratoconus progression, most likely associated with persistent ER habit, he was retreated with CXL in the right eye. Behavioral modification intervention for ER habit reversal was also applied.OutcomesCorneal cross-linking in combination with behavioral modification intervention for ER habit reversal prevented further KC progression.LessonsBehavioral interventions are likely to provide positive results in an ER habit reversal in children with ASD. Keratoconus treatment with CXL combined with behavioral management for ER reversal seemed effective in halting keratoconus progression in a young patient with ASD.

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