The discovery of keratoconus may have occurred as early as a 1748 doctoral dissertation. German oculist Burchard Mauchart gave a description of a case that may have been keratoconus. He named the problem as staphyloma diaphanum. By 1854, British physician John Nottingham reported the effects of keratoconus and clearly distinguished it from other ectasias of the cornea. Nottingham reported the cases of “conical cornea” coming to his attention, and described several classic features of the disease, including polyopia, weakness of the cornea, and difficulty matching corrective lenses to the patient’s vision.
Five years later, in 1859 British surgeon William Bowman used an ophthalmoscope to diagnose keratoconus, and described how to angle the instrument’s mirror so as to best see the conical shape of the cornea. Bowman also attempted to restore the vision by pulling on the iris with a fine hook inserted through the cornea and stretching the pupil into a vertical stenopeic slit like that of a cat. He reported that he had had a measure of success with the technique, restoring vision to an 18-year old woman who had previously been unable to count fingers at a distance of 8 inches (20 cm). By 1869, when the pioneering Swiss ophthalmologist Johann Horner wrote a thesis entitled On the treatment of keratoconus, the disorder had acquired its current name. The treatment at that time, endorsed by the leading German ophthalmologist Albrecht von Gräfe, was an attempt to physically reshape the cornea by chemical cauterization with a silver nitrate solution and application of a miosis-causing agent with a pressure dressing. In 1888 the treatment of keratoconus became one of the first practical applications of the then newly-invented contact lens, when the French physician Eugene Kalt manufactured a glass scleral shell which improved vision by compressing the cornea into a more regular shape. Since the start of the twentieth century, research on keratoconus has both improved understanding of the disease and greatly expanded the range of treatment options.
In 1989, it was discovered that there is increased enzyme activity which leads to corneal thinning in keratoconus corneas. Corneal thinning causes cone-shaped corneas and visual distortion that are often associated with keratoconus.
In individual patients, Keratoconus is frequently discovered during adolescence. Generally Keratoconus would be discovered during a complete eye exam from an optometrist or ophthalmologist. Signs within the cornea and progressive loss of vision would be signs that lead to the discovery of Keratoconus. Diagnosis of Keratoconus can be made with slit lamp inspection as well as other test such as pachymetry, keratometry, and corneal topography.