Munson’s Sign in Keratoconus
A 53-year-old man who had been admitted to the hospital after a fall and resultant femur fracture was noted to have an abnormal indentation of the lower eyelids. He had undergone corneal transplantation in both eyes — 13 years earlier on the right side and 17 years earlier on the left side — owing to increasing visual impairment over a 30-year period and difficulty in fitting contact lenses. In recent years, his vision had worsened, and his fall before admission had resulted from difficulty seeing a stairway. During bedside rounds, the lower-eyelid abnormality was noted by a medical resident. Further ophthalmologic examination was notable for a deflection of the lower eyelids when he was looking down, owing to dome-shaped eyes. The visual acuity was 20/70 in the right eye and 20/50 in the left eye. A diagnosis of keratoconus was made. Keratoconus is a noninflammatory disorder characterized by corneal thinning and bulging outward in a cone shape. In advanced cases, the eyelid deflection that was noted in this patient — known as Munson’s sign — can be seen. The patient was referred to the ophthalmology department and was placed on a waiting list for repeat corneal transplantation. The femur fracture was treated surgically, and the patient was referred for rehabilitation.