Patient presents with complaints consistent with keratoconus symptoms, including blurred vision, distorted vision, increased sensitivity to light (photophobia), and difficulty with night vision.  Progressive visual acuity changes were noted.  Examination revealed corneal thinning and irregular astigmatism, characteristic of keratoconus.  Corneal topography confirmed the diagnosis of keratoconus, demonstrating the characteristic cone-shaped cornea and steepening.  Current best-corrected visual acuity (BCVA) was documented.  The patient's medical history, family history, and ophthalmic history were reviewed.  Risk factors for keratoconus, such as eye rubbing, atopy, and Down syndrome, were assessed.  Treatment options, including specialty contact lenses (e.g., scleral lenses, rigid gas permeable lenses), corneal cross-linking (CXL), and intracorneal ring segments (ICRS), were discussed with the patient.  The patient's refractive error was evaluated for potential spectacle correction.  The importance of regular follow-up for keratoconus management and monitoring of disease progression was emphasized.  ICD-10 code H18.60 (keratoconus, unspecified) was assigned.  Future management may include consideration of keratoplasty (corneal transplant) if the condition progresses significantly and impacts the patient's quality of life.  The patient was educated on keratoconus prognosis and the importance of adhering to the prescribed treatment plan.