Hydrops in Keratoconus

Heard about corneal hydrops? This is a not so common complication found in patients with advanced keratoconus. What exactly happens when you develop corneal hydrops? The normal average thickness of a cornea is about 550 microns. When we were studying, our professor often says that it is thinner than a credit card. So, a patient with keratoconus may have corneas thinner than 500 microns, the thinnest so far I have seen is about 200 some microns. Now, when the cornea continues to thin down, some layers may break, which can cause fluid from the internal environment to leak out. In hydrops, the Descemet's membrane, which is the 4th layer of the cornea, ruptures, when this happens, the aqueous fluid inside the eye may leak towards the stroma-- the 3rd corneal layer--- causing corneal swelling. You may develop blurring of vision, glare and pain. When this happens, you have to quickly go to your corneal specialist who will be managing the condition. Conservatively, acute hydrops are managed with the use of antibiotics, cycloplegics, hypertonic solution and bandage contact lenses. If managed on time, vision may recover. What happens to the cornea? Scar from the hydrops can be seen, and the area of the cornea may be flattened.

Recently, I just fitted a 14 year old patient who had corneal hydrops. When he came in, he was not able to recognise faces for his right eye, after fitting him with scleral lenses, his vision improved to 20/24, which is 3 lines away from the best 20/20 line.

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