Purpose To describe a previously unreported posterior pseudo-lenticonus sign in a patient with nipple cone keratoconus (KC). Case report A 32-year-old female presented with complaints of right eye visual acuity loss. Although she was initially diagnosed with posterior lenticonus, the additional clinical evaluation revealed no true lenticonus. The corneal topography revealed a central nipple cone KC, and the crystalline lend finding was consistent with a pseudo-lenticonus. Conclusion Due to inadvertent visual effects, nipple cone KC may resemble posterior lenticonus.
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