# Hospital-Based Clinical Profile and Management Patterns of Keratoconus in Riyadh City, Saudi Arabia: A Multi-Center Cross-Sectional Study

## TL;DR

This study examines the clinical features and treatment patterns of keratoconus in Riyadh, Saudi Arabia, highlighting the role of eye rubbing and allergic symptoms.

## Contribution

The study provides a detailed hospital-based clinical profile of keratoconus in a Saudi population, emphasizing management patterns and severity associations.

## Key findings

- Keratoconus was commonly associated with eye rubbing and allergic symptoms.
- Tomographic indices and optical quality worsened with disease severity.
- Management patterns varied by sex and laterality, with corneal cross-linking more common in males.

## Abstract

Background and Objectives: Keratoconus (KC) is a progressive ectatic corneal disease that can cause irregular astigmatism and visual impairment. To describe the demographic and clinical profile of KC patients attending major eye care centers in Riyadh City, Saudi Arabia, and to explore associations with laterality, disease severity, and management patterns. Materials and Methods: This multi-center hospital-based cross-sectional study enrolled consecutive patients with a confirmed diagnosis of KC (new or follow-up) presenting between April 2022 and April 2023. All participants underwent standardized ophthalmic assessment and Scheimpflug tomography (Pentacam). Disease severity was categorized as early, moderate, or advanced using Pentacam-derived keratoconus staging, and ocular parameters (refraction, keratometry, pachymetry, and higher-order aberrations) were compared across severity categories. Results: A total of 157 patients (264 eyes) were included (mean age 31.8 years; 56.7% female), with bilateral KC in 68.2%. Eye rubbing (67.8%) and allergic symptoms (61.7%) were common. Keratometric indices and higher-order aberrations differed significantly by severity grade (p < 0.001). Management patterns differed by sex and laterality, with corneal cross-linking and glasses reported more frequently in males, and soft contact lens use concentrated among bilateral cases. Conclusions: In this hospital-based Riyadh sample, KC was often associated with eye rubbing and allergic symptoms and showed clear stage-dependent worsening of tomographic indices and optical quality. These findings support early detection and targeted counseling on modifiable behaviors, while population-based studies with non-diseased comparators are needed to quantify incidence and prevalence in Riyadh.