Objective:

To explore the relationship between hormonal fluctuations and the onset or progression of keratoconus (KCN), and to propose a screening approach for vulnerable groups.

Key Findings:

• 26 studies included, with 4,201 participants, showing a link between hormonal shifts and KCN onset or worsening.
• Pregnancy identified as the most common endogenous trigger for KCN.
• Elevated DHEAS consistently reported across studies measuring it, indicating a systemic component to KCN risk.

Interpretation:

The findings suggest that hormonal influences, particularly during significant fluctuations, play a critical role in KCN pathology and should be considered in clinical management.

Limitations:

• Evidence is largely observational, which may limit causal inferences.
• Variability in methodologies and diagnostic criteria across studies.

Conclusion:

Integrating hormonal history into keratoconus risk assessment could enhance screening and management strategies, particularly during periods of hormonal change.