Acute Corneal Hydrops

Q. Acute hydrops seen in:

A. Keratoglobus
B. Buphthalmos
C. Keratoconus
D. Bullous keratopathy

Answer: Keratoconus

Acute Hydrops

Acute hydrops of the cornea occur, manifested by sudden diminution of vision associated with central corneal edema. This arises as a consequence of rupture of Descemet's membrane and may be triggered by the patient rubbing the eye. The condition may be mistaken for extreme thinning with impending perforation. Acute hydrops usually clears gradually without treatment but often leaves apical and Descemet membrane scarring.


Corneal Hydrops in case of Keratoconus.

Predisposition: The progressive corneal thinning in advanced keratoconus can lead to a rupture in Descemet's membrane as well as the overlying endothelium. An influx of aqueous into the stroma results in immediate stromal and epithelial edema, opacification, and reduced visual acuity. Possible predisposing factors for the development of hydrops include the presence of systemic allergies, eye rubbing, Down's syndrome, rapid progression of ectasia, and eccentric cones.

Occurance: Corneal hydrops is known to occur in less than 5% of keratoconic patients. It has also been reported in other ectatic disorders such as pellucid marginal degeneration, keratoglobus, Terrien's marginal degeneration, and posterior keratoconus. Studies have shown hydrops occurs more commonly in males than females.
Note: Hydrops is much more common in Keratoconus than keratoglobus.
Management:  The management of corneal hydrops is primarily observation and topical therapy to relieve patient discomfort. Topical medications will not necessarily decrease the duration of corneal hydrops.

  • Hyperosmotic agents aid in reducing epithelial edema, but have little effect beyond the epithelium. If there is significant corneal compromise, a topical antibiotic can be considered to prevent a secondary infection. Corticosteroids or non-steroidal anti-inflammatory agents may be utilized for pain and inflammation. The use of corticosteroids may help reduce corneal scarring often seen in hydrops. Cycloplegics may also be used to ease pain while also reducing the potential for a secondary anterior chamber reaction. Anti-glaucoma medications may be used to decrease the hydrodynamic force on the posterior cornea.
  • Intracameral air has been used in the management of corneal hydrops. The air acts as a mechanical barrier, reducing aqueous flow into the stroma through the rupture in Descemet's membrane. Because the air is absorbed over a few days, the intracameral gases sulfur hexafluoride (SF6) and perfluoropropane (C3F8), in isoexpansile concentrations, have been used.
  • Hydrops that does not clear by 3 to 4 months is best treated by penetrating keratoplasty.

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