Cornea/Refractive Surgery Quiz 21

Yichieh Shiuey, MD | Massachusetts Eye and Ear Infirmary, Harvard Medical School

March 3, 1998
Figure 1
This is the eye of a young man with a history of hard contact lens use and a high degree of astigmatism who presented with acute pain and blurring of vision.
Questions and Answers
1. What is the diagnosis?
Answer: Corneal hydrops in a patient with keratoconus.

2. What is the anatomic cause of this clinical finding?
Answer: Rupture of Descemet's membrane with hydration of the stroma.

3. What is the acute management of the above finding?
Answer: Corneal hydrops may be treated by patching or a bandage contact lens, cycloplegia, and hypertonic sodium chloride ointment or drops. Topical steroids are usually not needed and may be a risk factor for corneal perforation.

4. What is the natural history of this conditon?
Answer: Corneal hydrops usually clears spontaneously over the course of several months.

5. When would corneal transplantation be indicated?
Answer: A corneal patch graft may be indicated in the acute situation if there is wound leakage. Penetrating keratoplasty for improvement of vision may also be indicated if the cornea does not clear sufficiently after several months.