Mitch Ibach, OD – Why Do Patients Rub?

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“Providing patients with effective treatments to decrease the eye-rubbing urges is paramount to their efforts. After they leave our office, building a team approach to boost awareness is a helpful tool for ceasing mechanical grinding.” – Dr. Mitch Ibach, Vance Thompson Vision

Have you noticed if your keratoconus patients are rubbing their eyes? While the exact cause of keratoconus is unknown, there are multiple factors that can contribute to developing the condition, and eye rubbing is one of them. There can be many reasons for corneal degeneration, but anecdotal and research-based evidence shows correlation between eye rubbing and the diagnosis and progression of keratoconus.

In a recent Mastering Keratoconus blog post on Primary Care Optometry News, Dr. Mitch Ibach, a residency-trained optometrist at Vance Thompson Vision in Sioux Falls, South Dakota, discusses what can cause eye rubbing and why people do it.

Dr. Ibach shares how touching and pressing on the eyes can become a constant habit so he asks patients being evaluated for keratoconus or corneal ectasia if they rub their eyes. More often than not patients deny it, but when asking the same question to a family member or friend accompanying the patient, the answer usually changes.

Dr. Ibach goes on to discuss certain ocular conditions that help drive eye-rubbing, including the three main culprits: atopy, inflammation, and loose/excess eyelid skin.

  1. Allergic conjunctivitis (atopy) is a common condition that leads to chronic itching and ocular pressure, which can be treated with topical and/or oral allergy medications to lessen the urge to itch.
  2. Ocular surface disease (inflammation) and external blepharitis can cause uncomfortable and watery eyes. Treatment options include artificial tears, anti-inflammatories, steroids, autologous tears, eyelid hygiene, thermal pulsation treatments, oral antibiotics, etc.
  3. Floppy eyelid syndrome can lead to excessive lid laxity and chronic papillary conjunctivitis, and patients are prone to eye-rubbing and dry eye. Treating the ocular surface can help reduce eye rubbing.

For those living with progressive keratoconus, Dr. Ibach’s management plan includes helping patients to stop rubbing their eyes and slowing or halting progression of the disease with iLink™ FDA-approved corneal cross-linking.

To learn more about eye rubbing and how it can be prevented, or if your keratoconus patients are medically indicated for iLink FDA-approved corneal cross-linking, read Dr. Ibach’s blog today.

Visit our website for more information on corneal cross-linking and follow us on Twitter, Facebook, and LinkedIn.

Suggestions offered by the physician are based on their experiences using the KXL® System and are their opinion. Medical decisions for your patients are to be based upon their condition and your medical judgment. The company does not recommend or endorse any particular course of treatment or medical choice.

Dr. Mitch Ibach is a paid consultant of Glaukos.

Using Photrexa® Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution), Photrexa® (riboflavin 5’-phosphate ophthalmic solution), and the KXL® System, the iLink™ corneal cross-linking procedure from Glaukos is the only FDA-approved therapeutic treatment for patients with progressive keratoconus and corneal ectasia following refractive surgery.*1

[Photrexa IFU/p1/col1/para3/lines1-4]


Photrexa® Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution) and Photrexa® (riboflavin 5’-phosphate ophthalmic solution) are indicated for use with the KXL System in corneal collagen cross-linking for the treatment of progressive keratoconus and corneal ectasia following refractive surgery.

Important Safety Information

Corneal collagen cross-linking should not be performed on pregnant women.

Ulcerative keratitis can occur. Patients should be monitored for resolution of epethelial defects. The most common ocular adverse reaction was corneal opacity (haze). Other ocular side effects include punctate keratitis, corneal striae, dry eye, corneal epithelium defect, eye pain, light sensitivity, reduced visual acuity, and blurred vision.

These are not all the side effects of the corneal collagen cross-linking treatment. For more information, go to obtain the FDA-approved product labeling.

You are encouraged to report all side effects to the FDA. Visit, or call 1-800-FDA-1088.

*Photrexa® Viscous and Photrexa® are manufactured for Avedro. The KXL® System is manufactured by Avedro. Avedro is a wholly owned subsidiary of Glaukos Corporation.


1. Photrexa [package insert]. Waltham, MA: Glaukos, Inc. 2016