Eye Rubbing and RNFL Thinning
Yes, frequent and forceful eye rubbing can cause retinal nerve fiber layer (RNFL) thinning and progressive optic neuropathy, even in the absence of elevated intraocular pressure.
Direct Evidence of Eye-Rubbing Optic Neuropathy
A documented case demonstrates that chronic, forceful bilateral eye rubbing over 20 years caused progressive optic neuropathy with pathological optic disc cupping and nerve fiber bundle visual field defects, mimicking normal tension glaucoma 1. The critical finding was that visual deterioration completely stopped only after the patient ceased the eye-rubbing habit, with stabilization maintained over 8 years of follow-up 1.
Mechanism and Clinical Presentation
The damage pattern from eye rubbing presents similarly to glaucomatous optic neuropathy:
- Bilateral optic disc cupping with progressive RNFL loss occurs despite normal intraocular pressures 1
- The mechanical trauma from repetitive eye rubbing likely causes direct compression and damage to the optic nerve head and retinal ganglion cell axons 1
- Visual field defects follow nerve fiber bundle patterns, indistinguishable from glaucoma 1
Diagnostic Considerations
Eye rubbing should be included in the differential diagnosis of any unexplained progressive optic neuropathy, particularly when:
- Optic disc changes and RNFL thinning occur with consistently normal IOP 1
- The patient is younger (fourth to fifth decade) without typical glaucoma risk factors 1
- There is bilateral symmetric involvement 1
Clinical Pitfall to Avoid
The most important caveat is that this condition can be misdiagnosed as normal tension glaucoma, leading to unnecessary glaucoma treatments while missing the reversible behavioral cause 1. A detailed history specifically asking about eye-rubbing habits is essential in any patient with unexplained optic neuropathy.
Management Approach
Immediate cessation of eye rubbing is the definitive treatment 1. Once the mechanical trauma stops, further visual deterioration halts and remaining function stabilizes 1. No additional interventions are necessary if the behavior is successfully eliminated 1.