Corneal Hydrops

Question 1

Predisposing factors

Answer 1

Corneal ectasia -> keratoconus mainly, but can occur in keratoglobus, pellucid marginal degeneration
Eye rubbing
Males
Asthma
VKC

Question 1

Aetiology

Answer 1

Corneal hydrous is an acute complication of corneal ectasia such as keratoconus, where aqueous flows into the cornea causing localised stromal and epithelial oedema. Typically due to rupture of Descemet’s membrane but can occur with an intact membrane also.

Question 2

Symptoms

Answer 2

Pain
Photophobia
Blurred vision - usually sudden
Watering
CL intolerance

Question 3

Signs

Answer 3

Stromal oedema with or without epithelial oedema - usually over a clear, well-demarcated area (typically inferior to cone).
Descemet’s membrane rupture may be visible, oedema can obscure view of posterior cornea and AC.

Conjunctival hyperaemia

Peripheral cornea spared but can. be affected in pellucid marginal degeneration

Question 4

Non-pharmacogolocial management in acute cases

Answer 4

Acute cases:
- Cease CL wear
- Avoid bandage CL wear (risk of hypoxia which can induce corneal vascularisation)
- Review weekly. Most cases resolve in 2-4 months with some degree of stromal scarring. If corneal vascularisation appears, refer urgently.

Question 5

Non-pharmacological management in resolved cases

Answer 5

Once acute corneal hydrops have resolved, re check corneal topography (often less steep after hydrops) - if refitting with CLs, you may need to check lens fitting as corneal profile may have changed

Question 6

Pharmacological management

Answer 6

Drops during day, ointment before bed

Sodium chloride 5% drops to draw water out of cornea.

Systemic analgesia for pain relief .e.g. ibuprofen

Cyclopentolate 1% for ciliary spasm relief

Topical antibiotic CPL1% if signs of infection or epithelial disruption

topical steroids such as DEXAMETHASONE QDS then tapered over a few weeks.

Question 7

Referral?

Answer 7

Refer urgently if corneal vascularisation present
Otherwise manage to resolution.

Question 8

What can they do at hospital?

Answer 8

Treat pain
Topical steroids
Topical antibiotics

Intracameral gas with or without compression sutures to bring oedematous and weak cornea closer to endothelium

DMEK - descemet membrane endothelial keratoplasty (replaces the diseased tissue only)
DSAEK - Descemet’s Stripping Automated Endothelial Keratoplasty
PK - penetrating keratoplasty (full thickness corneal transplant). This is done if scarring is affecting vision.
DALK - deep anterior lamellar keratoplasty (partial corneal transplant, leaving endothelium and Descemet’s intact)