Eye Rubbing in Children with Allergic Conjunctivitis Causes Corneal Topographic Changes

Symptoms of allergic conjunctivitis, especially in children, can lead to chronic eye rubbing. This not only exerts mechanical stimulation on the corneal epithelium and stroma, disrupting the epithelial barrier, but also damages the collagen structure of the cornea, potentially inducing structural abnormalities. In a recent study, researchers sought to characterize children with allergic conjunctivitis and evaluate their association with eye rubbing frequency and found that this action alters anterior elevation, creating a potential risk of biomechanical imbalance. The findings were reported in Translational Vision Science & Technology. Study shows that a potential pathological pathway linking eye rubbing frequency, anterior corneal surface morphology and corneal biomechanical abnormalities may exist in patients with allergic conjunctivitis. Photo: Niu X, et al. Transl Vis Sci Technol. 2025;14(10):18. Click image to enlarge. Included in this study were 66 children aged eight to 14 with diagnosed perennial/seasonal allergic conjunctivitis treated from January 2023 to March 2025. All underwent routine eye exams, corneal topography and corneal biomechanics assessments. The results were compared with 20 age- and sex-matched healthy controls. Eye rubbing frequency was documented, and the researchers correlated that with any evidence of altered corneal topographic and biomechanical parameters (corneal hysteresis and corneal resistance factor).Those with allergic conjunctivitis showed significantly higher anterior corneal elevation compared to healthy controls. “This parameter is critical for assessing corneal morphology, with maintenance influenced by the combined roles of the epithelium, Bowman’s layer and anterior stroma,” the authors wrote in their paper.Corneal surface height at the thinnest point and front difference deviation compared to healthy controls and were positively correlated with eye rubbing frequency. This suggests that allergic conjunctivitis and eye rubbing preferentially alter anterior elevation, with earlier and more pronounced effects compared to other parameters.Given the corneal shape alterations on display in this cohort, integrating anterior elevation and front difference deviation in kids with chronic ocular allergic conditions may help identify worrisome early changes, the researchers say.Regarding corneal biomechanical parameters, a decrease in corneal stiffness was found in the allergic conjunctivitis group, suggesting a potential risk of biomechanical imbalance in these patients.It’s been shown that eye rubbing is considered a risk factor for the development of keratoconus in patients with allergic conjunctivitis and can elevate the expression of proteases and inflammatory factors in tear film. “In allergic conjunctivitis, ocular surface inflammation leads to increased inflammatory mediators, and mechanical damage from eye rubbing further affects both the epithelium and stromal fibers of the cornea,” the authors explained in their paper. “These changes ultimately compromise corneal biomechanical stability. Therefore, both mechanical and inflammatory stimuli may synergistically contribute to alterations in corneal morphology and biomechanics, potentially triggering the onset of keratoconus.”The team concludes their paper by pointing out that their findings further support the notion that eye rubbing in allergic conjunctivitis “initially manifests on the anterior corneal surface.” Whether this can lead to biomechanical alterations that ultimately compromise corneal stability and result in corneal ectasia as the disease progresses and the duration extends requires further investigation, they noted.Click here for the journal source. Niu X, Qin A, Zhang W, et al. The effects of eye rubbing on corneal topography and biomechanics in children with allergic conjunctivitis. Transl Vis Sci Technol. 2025;14(10):18. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.