A Unique Retinoscopic Reflex Pattern in the Initial Stages of Keratoconus and Its Clinical Significance for Early Keratoconus Detection: A Case Report.

Keratoconus is a bilateral eye anomaly in which the cornea develops gradually, becoming steeper and thinner, causing irregular astigmatism and myopia. This unique case report highlights an atypical retinoscopic reflex that can be observed in the initial stages of keratoconus. While the reflex deviates subtly from the normal form, exhibiting a slightly distorted, irregular, and non-scissoring pattern, it differs significantly from the well-documented "scissor reflex," which is characteristic of moderate to advanced stages. This finding draws attention to the potential utility of the retinoscope in the early detection of keratoconus, particularly in settings with limited access to specialized diagnostic tools. Here, I report a case of a young woman, aged 19 years, who presented with symptoms of glare. During the retinoscopy examination, I observed a distorted and irregular appearance of the retinoscopic reflex, particularly in the left eye, in contrast to that of the right eye. Based on this finding, I suspected the presence of keratoconus. Corneal tomography was used to confirm the diagnosis of keratoconus, and the result was positive for keratoconus. This case report offers a novel clinical presentation that underscores the diagnostic challenges in the initial stages of keratoconus, making it a valuable addition to the literature. The primary lesson learned from this study is that the retinoscope plays a crucial role in the early detection of keratoconus.