Online Photo Diagnosis

By Gregory W. DeNaeyer, OD, FAAO

This photograph shows acute corneal hydrops on the right eye of a 42-year-old male patient who has severe keratoconus. The patient had been successfully wearing scleral contact lenses, but he had suddenly noticed a dramatic decrease in the vision of his right eye. Slit lamp exam showed marked central corneal edema with mild bullous changes. There was no sign of infection or inflammation. IOP measured 10mmHg. The patient had been wearing his contact lens and was not experiencing discomfort. His best-corrected visual acuity was 20/60 with his scleral lens.

Corneal hydrops is severe stromal and epithelial edema that results from a break in Descemet's membrane. It is a manifestation of ectactic disease such as keratoconus, pellucid marginal degeneration, and keratoglobus. Approximately 3 percent of keratoconus patients develop hydrops^1,2. Allergies and eye rubbing are risk factors^1,2. Recovery from the edema usually takes two to three months, and hyperosmotic therapy has limited efficacy. The patient is at risk for microbial keratitis if there is significant epithelial disruption, so consider prophylactic antibiotics. Pain can be managed with the use of a therapeutic contact lens. Resolution of hydrops can result in corneal scarring and flattening. Although flattening can make contact lens fitting easier, 60 percent will require a corneal transplant¹.

The featured patient is currently under observation. His visual acuity at press time had degraded to count-fingers vision. He wears his scleral lens during the day for pain management and applies Muro 128 ointment (Bausch + Lomb) every night.

References

1. Tuft, SJ. Gregory, WM. Buckley, RJ. Acute corneal hydrops in keratoconus. Ophthalmology 1994 Oct;101(10):1738-44.
2. Grewal, S. Laibson, P. Cohen, E. Rapuano, C. Acute hydrops in the corneal ecatasias: associated factors and outcomes Am J Ophthalmol. 200 May;129(5):702-3.