The genesis of keratoconus, a well kept “neuro-mystery”: a neurochemical and neurodegenerative point of view

Abstract

The act of rubbing eyes with hardness is believed to be one of the most frequent predisposing factors, but not the determinant, in the genesis of the corneal ectasia. However, to better understand this phenomenon, we should consider the cornea is the most densely innervated structure of the body, with cells aligned to unmyelinated nerve fibers that are guided by magneto-taxis waves with two different conduction directions: the arc reflex, where the stimulus generates an efferent response, and the arc where the stimulus generates an inflammatory process previous to their response. This is similar to what happens in the respiratory system or the gut where the inflammation is organized in the direction of the efferent stimuli. These initial stimuli, from the processes which finally are generating the act of rubbing eyes, are similar as it happens with the cough reflex or the bowel movements.
When the corneal ectasia stages are progressing, clearly is possible to observe disorganization and rupture of the sub-basal nervous plexus, as well as changes in metabolites, secondary to the neurodegenerative process. To improve diagnosis and futures treatments, it is mandatory to identify what is leading those changes, which are expressing and affecting structural alterations of the corneal collagen.