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We report two cases of suspicious asymmetric bow tie and inferior steepening on topographic evaluations with reflection (Placido) and projection (Scheimpflug). Rotating Scheimpflug corneal and anterior segment tomography (Oculus Pentacam HR, Wetzlar, Germany)® was performed in the first case, with a maximal keratometric value (Kmax) of 43.2 D and an overall deviation value from the Belin/Ambrósio Enhanced Ectasia Display (BAD-D) of 1.76, which was observed in the study eye (OD). BAD-D was 6.59 in the fellow eye, which had clinical findings that were consistent with keratoconus stage 2. The second case presented with a Kmax of 45.3 D and BAD-D of 0.76 in OD and 1.01 in OS. This patient had discontinued wearing soft contact lens less than 1 day prior to examination. Corneal tomographic data enabled us to distinguish mild or forme fruste keratoconus from contact lens-induced corneal warpage, and similar findings were observed on curvature maps.

Differentiation of mild keratoconus from corneal warpage according to topographic inferior steepening based on corneal tomography data