Keratoconus Houston

That subtle brown arc isn’t damage—it’s a Fleischer ring, a common sign of keratoconus caused by iron in tears collecting around the cone

This patient is suffering from a condition very closely related to keratoconus, called keratoglobus. While keratoconus causes thinning and bulging of the cornea in one small area, keratoglobus causes thinning and bulging of the entire cornea. Because of this, keratoglobus patients are typically not great candidates for cornea transplant.

Have you ever looked into the eye of a warrior?

I shared these words a few years back, but their truth still hits just as hard today. Some messages are meant to last—this is one of them.

This is the eye of a United States Navy SEAL. It has seen training to the point of true exhaustion. It has dried out from countless HALO jumps. It has helped disarm underwater and roadside bombs, assaulted enemy positions, and assessed life and death situations with the same focus required to neutralize a moving target on rough seas, from the deck of a moving ship.

This eye belongs to a patient who turned into a friend. The kind of friend who changes your life for the better.

It has seen families torn apart, and families saved, from some of the worst humanity has to offer. It has wept from looking at the bodies of friends and innocents who have died as a result of fighting the fights that needed to be fought, as well as those that didn’t. It has seen true bravery. The kind that only grows on the battlefield.

This is not my usual cornea/contact lens/anterior segment pathology post. I won’t discuss the pathophysiology, or fitting process. The photos are to simply say...this is what a real person willingly sacrificed for his country, and we have the power to make his life better.

Memorial Day deserves more than BBQ and potato salad. It deserves the telling of stories of those who gave their lives in service to this country. But there is a problem... most of those stories don’t have a narrator. So I will settle for those who’s stories can give us a glimpse of the lives of the men and women who wake up each day and choose to make their priority something bigger than themselves.

His story...

He had come to me with an ocular surface distorted from trauma, and multiple surgeries.

In our many conversations, I learned he was a Navy SEAL, and he and his team were injured while attempting to disarm a roadside bomb in Afghanistan.

Treating patients with war injuries was commonplace for me at the time, but the many injuries and surgeries on his medical record were not. Our visits were always long. I struggled with small diameter lenses that wouldn’t stabilize on such an irregular graft. We had some success with intralimbal lenses, as they were easier for him to apply with the two fingers he had left to work with. But scar tissue under the lid caused problems. The same scar tissue prevented the ideal correction, a large diameter scleral lens. But we were able to achieve a reasonably good fit with a corneo-scleral lens, and an intralimbal lens with a Korb edge.

As severe as his injuries were, he never complained. Never blamed The multiple failures of application and removal on anyone, including himself. It was a mission. And he threw himself into it, and did what he had to do to complete it.

As he was leaving one day, I stood in the hall and watched him go. My next patient happened to be walking up as he was leaving. They stoped, spoke a few words, and with a laugh, and slap on the shoulder, they parted ways.

As my patient came in, I asked “How do you know the Chief?” He (also a Navy SEAL) said with a smile...”Oh, I’m the guy that put him out”. I said, “what do you mean you’re the guy that put him out?” He said...”when he was on fire. I’m the the guy that put him out.”

It wasn’t the statement that hit me so hard. It was the manner in which it was given. Like...it was no big deal. Like, it was a natural thing you do. A bomb had detonated at close proximity. The entire SEAL team was hit by the blast. All suffered injuries. Yet...”when he was on fire”, this man’s priority was clear. It was never in question.

Many times, I witnessed similar actions that left me humble and proud. This is what our country is really made of. It’s not the stuff that is sent out on tv and social media. For those we have lost, I am both sad and grateful. But most of all, I am inspired to live with meaningful purpose. To teach my kids to make a habit out of doIng the things that need to be done. And to, once a year, reflect on the free men and women who sacrificed doing the superhuman things that remind us how truly human we all are.

Enjoy and appreciate what you have this Memorial Day weekend. Tell stories if you have them. Remember those just like you who chose to protect, and in doing so, lost their lives.

This is a keratoconus patient who underwent a cornea transplant (penetrating keratoplasty), and later developed cancer on her upper eyelid. Multiple surgeries and radiation severely altered the eyelid tissue and the patient can no longer close the eye. She wears a Scleral lens both for vision and to protect the eye from the environment. Visual acuity with her lens is 20/20!

Photo of a cornea graft rejection. The corneal haze is due to swelling, as are the “bubbles” on the front of the cornea (called bullae).

We all lose the ability to focus up close as we age. The focusing lens inside the eye becomes progressively stiff as we age, leading us all to eventually need help focusing on anything at arms length or closer. While not all keratoconus patients are a candidate, there are options in rigid gas permeable (RGP) lenses that can correct all three distances when fit properly. This is a lens with 3 separate powers; one power for distance, one for intermediate distances, and one for near. Not all doctors will fit these lenses due to their complexity, but when a successful fit has been obtained, the improvement in clarity at all distances is impressive.

Limbal stem cell transplant in a patient with bilateral limbal stem cell deficiency (LSCD) secondary to severe chronic exposure from Sjögren’s syndrome. There are a few different types of limbal stem cell transplants, but the type shown here is a keratolimbal allograft (I.e. from a deceased donor).

Here’s a fascinating look at a patient overcoming not one but two significant eye conditions—keratoconus and entropion—with the help of a custom scleral lens.

🔍 Keratoconus causes the cornea to thin and bulge into a cone shape, leading to distorted vision.
🔄 Entropion makes the eyelids turn inward, causing the lashes to rub against the cornea—painful and irritating!

So, how does a scleral lens help? Unlike regular contacts, these large-diameter lenses vault over the cornea, providing a smooth optical surface while also protecting the eye from irritation caused by the in-turned eyelid. The result? Clear vision, less discomfort, and a much happier eye!

This case is a great reminder of how innovative solutions can restore both sight and comfort—even in the most complex cases.

📸 What do you think of this transformation? Drop a 👁 in the comments if you love seeing vision-saving innovations in action!

A cornea transplant is stabilized with sutures. However, sometimes a transplant can rupture at the location it connected. This is called a graft dehiscence. When a part of the graft ruptures, the iris will often be pulled toward the rupture an plug the gap. Notice the pupil peaking toward the dehiscence.

This is a Boston Keratoprosthesis. It is a type of artificial cornea used on individuals who are not candidates for traditional cornea transplants.