Behaviour modification in the management of chronic habits of abnormal eye rubbing.

OBJECTIVES: To describe how and why many keratoconus patients do not comply with strong advice to control chronic habits of abnormal rubbing. To outline a behaviour modification approach for controlling chronic habits of abnormal rubbing. METHODS: Common reasons for chronic habits of abnormal rubbing have been reviewed as a basis for specifying a behavioural modification approach to habit reversal. RESULTS: The methods described are organized into the classic behavioural modification structure of: (1) habit awareness, (2) competing responses, (3) development of motivation, and (4) social support. This structure is supported by the application of social influence principles to achieve optimum compliance. CONCLUSIONS: The use of take-home written information in the form of an Abnormal Rubbing Guide is the basis for the development of motivation. Family social support is based upon a widening of the responsibility for avoiding eye rubbing to all family members. Some patients will need minimal application of these principles with patient education being sufficient intervention to achieve habit reversal. For patients with strong provocation to rubbing and/or by having a well established rubbing habit, a greater exposure to the habit reversal program described is indicated. Successful habit reversal may slow the rate of ectasia progression. Prophylactic application of the methods described for patients who are at risk for developing keratoconus, or post-laser assisted in situ keratomileusis keratectasia, may show that some forms of keratectasia are preventable.

Management of chronic habits of abnormal eye rubbing.

A review of the provocations and the consequences of chronic habits of abnormal rubbing indicates a range of possible adverse responses. Gentle rubbing may double intraocular pressure. However, the combination of tight eye closure and forceful rubbing may raise intraocular pressure to more than 10 times normal levels. The possibility that, in susceptible individuals, chronic habits of abnormal rubbing may lead to the development or progression of keratoconus has been extended to the possibility of rubbing related adverse responses in other diseases and conditions. The adverse consequences of rubbing appear to be active processes, in contrast to the apparent passive nature of any recovery from those responses. Avoidance of the possibility of permanent adverse changes is clearly preferable. However, advice to avoid rubbing may not be successfully followed. Education and counseling appear to be the foundations for helping patients to control chronic habits of abnormal rubbing. An instrument has been developed as the basis for patient education and counseling for this purpose. It is intended as a take-home document which might have relevance to other family members. The widening of the application of this form of patient education to all members of a family, and a wider range of conditions, may produce beneficial synergy with advantage to patients who may have the most to gain from controlling chronic habits of abnormal rubbing.