Corneal hydrops, advanced keratoconus, acute corneal edema - A State of Sight #21

In keratoconus, the cornea progressively thins and protrudes into a cone shape. If this becomes severe, an inner-layer break in the cornea can occur, causing corneal hydrops. Acute hydrops results in pain, redness, decreased vision, and corneal swelling. In this episode of A State of Sight, Isaac Porter, MD explains corneal hydrops and the treatment options.

Welcome to A State of Sight, I’m your host, Isaac Porter, from Porter Ophthalmology and this is your update in ophthalmology and eye care from Raleigh, North Carolina. In this episode, I would like to explain corneal hydrops, which is a problem may occur in some patients with keratoconus.

To better understand this, let's review keratoconus, which is a problem of the cornea (the clear shield that covers the front of the eye). In people with keratoconus, instead of having a nice dome shape, the cornea can bulge and protrude forward to take on more of a cone shape.

This can cause a large amount of astigmatism and distortion in vision that can keep people from seeing clearly. Early on, this usually progresses and worsens, but once patients make it into their 40’s, 50’s and 60’s with keratoconus, the changes usually become less and less.

Many times this is seen as early as the teens or 20’s when patients may notice that glasses do not correct their vision adequately. Patients may need to switch to soft or rigid gas permeable contact lenses in order to obtain their best vision.

As keratoconus continues to progress and the cornea becomes thinner, a corneal transplant or other operations may be necessary to restore the cornea to a normal shape. Then, vision may improve and contact lenses may be able to be used again.

Corneal hydrops occurs when the cornea becomes so thin and distorted that there is a break in the back layers of the cornea (including the recently discovered Dua Layer). This break then allows the fluid filling the inside of the eye (aqueous humour) to enter the cornea, causing corneal swelling and clouding.

Usually the cornea is thin and clear but with hydrops, it becomes swollen and thicker. This can cause pain, sensitivity to light, and patients sometimes notice they get a red eye that starts spontaneously.

When corneal hydrops decreases vision, it may take some time to resolve, but it usually improves over months. The break of the back layers of the cornea eventually heals. This gives the cornea a chance to become thin again by pumping out the fluid that is causing the swelling.

The healing process can potentially be quicker if we put an injection of air or gas into the front of the eye. This allows a bubble to float against the back of the cornea, helping to seal the break more quickly. People that don’t have this can try using strong saline drops to help decrease swelling, but the natural healing process for hydrops will take up to two to three months.

In the end, once the cornea has recovered, we will take a look to determine how clear the cornea is and then decide the best way to improve vision. Fortunately, many times we see flattening of the cornea after hydrops, which can make contact lenses easier to wear and vision better. However, if there is significant corneal scarring afterwards, it may require a corneal transplant to obtain the best vision.

If you have any questions about keratoconus or corneal hydrops, please comment below. We look forward to interacting with you and hope to see you soon on a State of Sight.

Do you have keratoconus or have you experienced hydrops? Give us a call at 919 876 4064 to schedule an evaluation.