Name of the Condition

• Keratoconus, unstable, bilateral (ICD Code: H18.623)

Summary

Keratoconus is a progressive eye disorder where the normally round cornea thins and begins to bulge into a cone-like shape. This can significantly affect vision, as the cone shape deflects light as it enters the eye, causing distorted vision.

Causes

The exact cause of keratoconus is not fully understood but is believed to be a combination of genetic, environmental, and hormonal factors. It often manifests during adolescence.

Risk Factors

• Family history of keratoconus
• Chronic eye irritation or rubbing
• Allergies and asthma
• Certain genetic disorders, such as Ehlers-Danlos syndrome and Down syndrome

Symptoms

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

Diagnosis

• Comprehensive eye exams including corneal topography.
• Corneal pachymetry to measure corneal thickness.
• Slit-lamp examination.

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

With early diagnosis and appropriate treatment, vision complications can be managed. Regular check-ups are vital to monitor progression and adapt treatment plans promptly.

Complications

• Severe vision impairment
• Scarring of the cornea
• The need for corneal transplant if left untreated

Lifestyle & Prevention

• Avoid eye rubbing, which may exacerbate the condition.
• Use protective eyewear to avoid eye injuries.
• Manage allergies to reduce eye irritation.

When to Seek Professional Help

• Noticeable and sudden changes in vision
• Increasing difficulty with night vision
• Frequent changes in eyewear prescriptions

Additional Resources

• National Keratoconus Foundation (NKCF) for patient support and education.
• American Academy of Ophthalmology for professional guidelines and updates.

Tips for Medical Coders

• Confirm the diagnosis as bilateral and unstable keratoconus to assign the proper ICD code H18.623.
• Ensure accurate documentation of related treatments or procedures as they can influence coding decisions.