In fact, the micro-trauma caused to the epithelium by the eye rubbing generates high levels of matrix metalloproteases (MMP-1 and MMP-13) secreted by the epithelial and stromal cells, in addition, the release of inflammatory mediators (IL-6 and TNF-α) is one of the processes leading to KC and its progression.[35]. Here, MMP13 is linked to keratoconus.