H18.60 Keratoconus, unspecified

Name of the Condition

• Keratoconus, unspecified (ICD Code: H18.60)

Summary

Keratoconus is a progressive eye disorder characterized by the thinning and bulging of the cornea into a cone-like shape. This structural change distorts the cornea's curvature, leading to irregular astigmatism and blurred or distorted vision. The condition typically affects both eyes, though often asymmetrically, and can worsen over time.

Causes

The exact cause of keratoconus is not fully understood, but it is thought to involve a combination of genetic predisposition, environmental factors, and hormonal influences. Some cases may be associated with systemic conditions or eye trauma, though many occur without a clear underlying trigger.

Risk Factors

• Family history of keratoconus
• Chronic eye rubbing or irritation
• Allergic conditions (e.g., atopic dermatitis, asthma)
• Certain connective tissue disorders (e.g., Ehlers-Danlos syndrome)
• Down syndrome

Symptoms

• Blurred or distorted vision
• Increased sensitivity to light and glare
• Frequent changes in eyeglass or contact lens prescriptions
• Difficulty seeing at night or in low light
• Eye strain or headaches

Diagnosis

Diagnosis involves a comprehensive eye examination, including slit-lamp microscopy to assess corneal shape and clarity. Corneal topography is used to map the cornea's curvature and detect irregularities. Pachymetry may measure corneal thickness, and refraction tests assess visual acuity.

Treatment Options

• Eyeglasses or soft contact lenses for mild cases
• Rigid gas permeable contact lenses for advanced cases
• Corneal collagen cross-linking to strengthen the cornea
• Intacs, small corneal inserts, to reshape the cornea
• Corneal transplant for severe cases

Prognosis and Follow-Up

Prognosis varies depending on the severity and progression of the condition. Early diagnosis and treatment can slow progression and preserve vision. Regular follow-up with an eye care specialist is essential to monitor changes and adjust treatment as needed.

Complications

• Severe vision loss if untreated
• Corneal scarring
• Increased risk of corneal hydrops (sudden swelling)
• Difficulty fitting contact lenses

Lifestyle & Prevention

• Avoid rubbing the eyes, especially if prone to allergies or irritation
• Use proper contact lens hygiene to reduce eye irritation
• Protect eyes from trauma or injury
• Manage underlying conditions like allergies to minimize eye rubbing

When to Seek Professional Help

Seek immediate medical attention if you experience sudden vision changes, severe eye pain, or increased sensitivity to light, as these may indicate complications like corneal hydrops.

Tips for Medical Coders

Use H18.60 for unspecified keratoconus when documentation does not specify laterality, stability, or other details. Ensure the diagnosis aligns with clinical findings, as coding requires specificity when available. Document any associated factors (e.g., family history, eye rubbing) to support the diagnosis if needed.