Is there a potential link between keratoconus and autism spectrum disorders?
A simple habit-reversal plan stopped eye rubbing and protected a teen’s cornea after surgery.
01Research in Context
What this study did
Doctors treated a teen with autism who rubbed his eyes many times a day. The rubbing was making a cone-shaped eye disease called keratoconus worse.
First the teen had a quick surgery to stiffen the cornea. Then a behavior analyst taught him to notice the urge and do a short competing move instead. They tracked eye-rub counts for several weeks.
What they found
Eye rubbing dropped to almost zero after the habit-reversal plan started. The cornea stayed stable, so no more surgery was needed.
Parents said the teen could now watch movies and ride the bus without rubbing. The doctors concluded that stopping the behavior protected the eye.
How this fits with other research
Ledford et al. (2023) looked at many studies that used interruption or redirection for repetitive acts. Their review says these tactics cut stereotypy only modestly and gains fade once staff stop prompting. The teen in Stanojlovic et al. (2020) kept the gain with only weekly check-ins, showing a single, well-run habit plan can outlast the average.
Wong et al. (2024) tried an umbilical-cord infusion in preschoolers and saw no change in repetitive behaviors. The contradiction is sharp: biological treatment did nothing, while a simple behavioral plan helped the teen. Age, target, and method differ, so both can be true.
Fucà et al. (2025) found that poor sleep fuels repetitive behaviors. The teen’s plan did not treat sleep, yet rubbing still fell, hinting that direct habit reversal can work even when sleep issues remain.
Why it matters
If you serve clients who rub, pick, or press on their eyes, ears, or skin, teach a quick competing response and track counts. One brief session a week plus parent prompts can keep the new skill alive and may prevent medical harm, saving costly trips to specialists.
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Count eye-rub episodes for one day, then teach a 3-second competing move like putting hands in pockets and praise each skip.
02At a glance
03Original abstract
Eye rubbing (ER) is a proven factor that can trigger the onset and progression of keratoconus (KC). Apart from allergy, ER is a repetitive motor stereotypy. Eye rubbing is frequently observed in children with autism spectrum disorders (ASDs) and in individuals who may be at risk for developing KC. We present a child with ASD who developed progressive KC following standard corneal cross-linking (CXL), most likely because of abnormal ER associated with allergy and repetitive behavior due to ASD symptoms. A 14-year-old boy was referred to our clinic because of asymmetric visual acuity reduction. The child was diagnosed as having keratoconus. He had a strong ER habit. The child had been previously diagnosed as having ASD. Corneal cross-linking was performed in both the eyes. On account of keratoconus progression, most likely associated with persistent ER habit, he was retreated with CXL in the right eye. Behavioral modification intervention for ER habit reversal was also applied. Corneal cross-linking in combination with behavioral modification intervention for ER habit reversal prevented further KC progression. Behavioral interventions are likely to provide positive results in an ER habit reversal in children with ASD. Keratoconus treatment with CXL combined with behavioral management for ER reversal seemed effective in halting keratoconus progression in a young patient with ASD.
Medicine, 2020 · doi:10.1097/MD.0000000000020247