Keratoconus in Marfan syndrome: Is it a paradox?

Ocular manifestations of Marfan syndrome (MFS) include features such as ectopia lentis (most common), increased axial length, and flat cornea. Reports of keratoconus in such patients are limited. We report tomographic findings consistent with keratoconus in a patient with MFS. A 15-year-old male presented with gradually progressive decreased vision in both eyes. External physical features being consistent with MFS, on ocular examination, was found to have very high average keratometries bilaterally with tomographic evidence of advanced keratoconus. Although a rare presentation, concurrent MFS and keratoconus should be considered when reviewing the ocular health of MFS patients and appropriate management steps should be taken upon the diagnosis.