Purpose: To report 5 cases of advanced unilateral keratoconus documented by sequential tomographic evaluation.
Methods: Retrospective review over a 10-year period at a single practice identifying patients with unilateral keratoconus by advanced imaging throughout the follow-up period.
Results: Five patients were identified with progressive keratoconus in 1 eye and no changes in the fellow eye based on full tomographic evaluation and analysis of both anterior and posterior corneal surfaces and corneal thickness with a mean follow-up period of 59 months (range 39-86).
Conclusions: Keratoconus is believed to be a bilateral disease that can present asymmetrically. We present 5 cases that appear to be true unilateral keratoconus with no associated mechanical environmental factors.