Surgical Management of Keratoconus in a Young Adult with Cognitive and Behavioral Disability

Case Presentation: A 25-year-old man with cognitive impairment (CI) and behavioral issues presented for corneal collagen crosslinking (CXL) surgical management of progressive keratoconus. Results: The conventional CXL technique was modified to avoid complications due to potential postoperative behavioral issues. Conclusions: Significant post-operative pain and aggressive behaviour can occur following epi-on CXL. Aggressive behaviour can result in significant complications in relatively low-risk eye surgery. Preoperatively, it is appropriate to devise a multifaceted surgical, medical and behavioural treatment plan including psychotropic if needed in patients with history of cognitive impairment and aggressive behaviour.