Eye Rubbing and Retinal/RNFL Damage
The evidence does not support that mechanical stress from eye rubbing directly injures the retina or reduces RNFL thickness. Eye rubbing primarily causes anterior segment complications, particularly corneal damage and keratoconus, while posterior segment effects are rare and indirect.
Primary Effects: Corneal Damage, Not Retinal Injury
The overwhelming evidence demonstrates that chronic eye rubbing causes corneal complications rather than retinal or RNFL damage 1, 2. The mechanical trauma from vigorous rubbing leads to:
- Keratoconus development through corneal thinning, loss of rigidity, elevated epithelial temperature, increased intraocular pressure spikes, and inflammatory mediator release 1
- Corneal remodeling and ectatic disorders via multiple mechanisms including reduced ground substance viscosity, collagen fibril slippage, and biomechanically coupled curvature changes 2
- Reversible corneal ectasia in pediatric patients, which can normalize when rubbing ceases 3
Rare Posterior Segment Complications
While eye rubbing predominantly affects the anterior segment, posterior segment disorders are mentioned but extremely uncommon 1. These include:
- Glaucomatous optic neuropathy (likely secondary to IOP spikes rather than direct mechanical trauma) 1
- Retinal detachment 1
- Extrusion of implanted silicone oil 1
Importantly, these posterior complications are not described as direct mechanical injuries to the retina or RNFL from the rubbing itself, but rather as secondary consequences of the acute pressure changes and structural disruptions.
RNFL Thinning: Unrelated Contexts
The provided evidence discussing RNFL thickness changes relates to completely different pathologies (multiple sclerosis with optic neuritis 4 and glaucoma with disc hemorrhage 5) and has no connection to eye rubbing as a causative mechanism.
Clinical Implications
The primary concern with chronic eye rubbing is progressive keratoconus and corneal complications, not retinal injury 1, 2. Prevention strategies should focus on:
- Eliminating eye rubbing in at-risk populations (young children, patients with ocular allergies, vernal keratoconjunctivitis) 1
- Aggressive management of underlying conditions that trigger rubbing (particularly allergic eye disease and itching) 1
- Early intervention in pediatric patients where corneal changes may still be reversible 3