HISTORY
A 30-year-old Caucasian female presented for a scleral lens fit. She had a history of keratoconus in both eyes, but it was worse OS. She stated that she could not see well with her glasses.
EXAM FINDINGS
All entrance testing appeared normal. Visual acuities were reduced OU (OS > OD) at distance and near. Slit lamp was positive for Fleischer rings in both eyes. An additional finding was noted OS (Figures 1-3). An anterior segment optical coherence tomography (OCT) was obtained over the area of concern (Figure 4).
DISCUSSION
Keratoconus can have several complications from mild thinning/scarring to corneal hydrops. Corneal hydrops occur when Descemet’s membrane is torn and fluid from the aqueous fills the corneal stroma.1 Patients will present with marked reduced visual acuity, photophobia, and pain.1 Risk factors for developing corneal hydrops include vernal keratoconjunctivitis, asthma, atopic dermatitis, black ethnicity, previous hydrops, contact lens use, and K values steeper than 48D.2 When Descemet’s layer is broken, it will roll up with the endothelium and create a gap between the stroma and aqueous.1 This is consistent with what was found in Figures 1-3.
CONCLUSION
After further discussion with the patient, it was revealed that she had what appeared to be previous corneal hydrops. The finding OS was a suspected break in Descemet’s from a previous corneal hydrops occurrence. The corneal hydrops has since resolved, but the break in Descemet’s remains.
REFERENCES
- Maharana PK, Sharma N, Vajpayee RB. Acute corneal hydrops in keratoconus. Indian J Ophthalmol. 2013 Aug;61:461-464.
- Barsam A, Brennan N, Petrushkin H, et al. Case-control study of risk factors for acute corneal hydrops in keratoconus. Br J Ophthalmol. 2017 Apr;101:499-502.
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