Acute Corneal Hydrops

A 40-year-old man experienced painful acute loss of vision in the left eye. Ophthalmological examination revealed the “acute form” of keratoconus (Figure a). Keratoconus is a non-inflammatory, often progressive, irregular bulging and thinning of the cornea. A complication of the disorder results in acute corneal hydrops, in which the severely thinned and stretched Descemet’s membrane tears, causing aqueous humor leakage and massive corneal stromal edema (Figure b). Keratoconus usually becomes symptomatic in puberty and stabilizes by the age of 30–40 years. Incidence rates are 1.5–25 cases per 100 000 persons/year. Possible sequelae include: irregular astigmatism, myopia, diminished visual acuity, and in around 3%, acute corneal hydrops. Risk factors include neurodermatitis and excessive eye-rubbing. According to the stage, treatment involves, for example, the use of rigid contact lenses, corneal cross-linking, or at advanced stages, corneal transplantation (perforating keratoplasty). Our patient was successfully treated with deep-stromal adapting sutures in the cornea and excimer laser-assisted perforating keratoplasty. The patient’s vision recovered to uncorrected 0.16 on the fifth postoperative day.

Figure

Side view of the left eye / Optical coherence tomography

Marie Elisabeth Burghardt, Prof. Dr. med. Arne Viestenz, Universitäts- und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale),[e-mail]

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Burghardt ME, Viestenz A: Acute corneal hydrops. Dtsch Arztebl Int 2025; 122: 143. DOI: 10.3238/arztebl.m2024.0226