Keratoconus (KC) is a progressive corneal disorder characterized by thinning and conical protrusion, leading to visual impairment. Whereas traditionally viewed as non-inflammatory, recent evidence highlights the role of chronic inflammation, oxidative stress, and genetic susceptibility in its pathogenesis. A literature review was conducted using PubMed, Embase, and Scopus databases focusing on keratoconus etiology and risk factors. The most significant factors include eye rubbing, male sex, time spent using computers after work or school, and exposure to dust or particulates in the workplace. Additionally contributors include environmental factors (UV exposure, air pollution) and systemic conditions (connective tissue disorders, autoimmune diseases). Developing research also ensnares lifestyle factors such as poor nutrition, sleep disruption, and psychological stress in disease progression. Advances in genetic and epigenetic studies uncover dysregulation in corneal structure and repair mechanisms, while microbiome imbalances may further exacerbate inflammation. This review synthesizes current knowledge on KC's multifactorial etiology, emphasizing the shift toward holistic management strategies that address both ocular and systemic factors. Environmental exposures, daily habits, and systemic health converge to influence keratoconus onset and progression for understanding this enigmatic disease. Future directions include personalized therapies focusing on fundamental molecular pathways and public health measures to moderate environmental risks.
Ćwiek et al. (2025) studied this question.