Abstract
INTRODUCTION: Keratoconus (KC) is the most prevalent corneal ectasia in the world and its pathogenesis is influenced by both ocular and systemic factors. This review explores the multifaceted associations between keratoconus and systemic health conditions, ocular characteristics, and various other environmental/exogenous factors, aiming to illuminate how these relationships influence the pathophysiology of the disease. AREAS COVERED: This review will summarize the fundamental attributes of KC, review and discuss the systemic and ocular association of KC including molecular biomarkers, and provide an organized overview of the parallel alterations occurring within various biological pathways in KC. EXPERT OPINION: Despite the substantial volume of research on keratoconus, the precise etiology of the disease remains elusive. Further studies are necessary to deepen our understanding of this intricate disorder and improve its management.