Keratoconus and Dry Eye Symptoms: What a Review of 7 Studies Found

People with keratoconus often describe their eyes as tired, gritty, or irritated, not only blurry. Some of that discomfort may come from specialty lenses, but researchers have also wondered whether the eye surface itself is different in keratoconus. A systematic review and meta-analysis published in October 2026 in Frontiers in Medicine pulled together the available studies.

What the researchers did

A team in Changsha, China, searched four databases through September 1, 2026, for studies comparing people with keratoconus to people without it. They looked at symptom scores on the Ocular Surface Disease Index (OSDI), tear breakup time measured with dye and without dye, tear production (Schirmer test), and dry eye diagnoses. Seven studies qualified, with 359 people with keratoconus and 333 controls.

What they found

• Symptom scores were clearly higher in keratoconus, by about 19 points on the OSDI, and this finding held up in sensitivity checks.
• Tear breakup time with dye was shorter on average, but the difference was not statistically significant.
• All three studies that measured tear breakup time without dye found lower values in keratoconus, but the data could not be pooled reliably.
• Tear production results varied from study to study.

The authors’ cautions

The number of studies was small, and they measured things in different ways. The authors called for larger, multicenter studies with standardized tear testing.

What this means if you have keratoconus

If your eyes feel uncomfortable, you are not imagining it, and it is worth bringing up. Eye-surface problems can make lenses harder to wear and may lead to more rubbing, which is linked to keratoconus.

• Mention dryness, burning, or lens intolerance at your visits, not only blur.
• Ask whether your lens fit, solution, or wearing schedule could be adjusted.
• Preservative-free artificial tears and lid care may help; ask what fits your situation.
• Avoid rubbing your eyes, and treat allergies that make you want to rub.

Keratoconus care is provided by cornea specialists and specialty-lens fitters. For more plain-language reading on eye health, see best-lasik-surgeon.com.

Source: Ocular surface symptoms and tear-film parameters in keratoconus: a systematic review and meta-analysis (Frontiers in Medicine (PubMed), 10/15/2026). This article is an educational summary written by Khanna Vision Institute and is not a substitute for medical advice.