Corneal hydrops is the acute onset of corneal edema that results from a break in Descemet’s membrane (basement membrane that lies between the corneal endothelium and the corneal substance). It is seen in patients with progressive worsening of keratoconus, a noninflammatory disorder of the cornea characterized by progressive thinning and cone-shaped protrusion, as well as patients with ocular disease processes with corneal distention. In corneal hydrops, severe corneal edema develops. Patients typically experience sudden photophobia and decreased visual acuity. Hydrops can resolve without treatment after several weeks to months, but patients may experience eye pain and decreased vision until the corneal edema improves. Hydrops can also lead to permanent corneal scarring or, rarely, perforation.
Management and Disposition
Evidence for effective treatment is minimal, but treatments include pressure patching, bandage contact lens use, topical steroids, and cycloplegics. Placement of gas or air in the anterior chamber can decrease the time to resolution of hydrops but does not change the incidence of long-term corneal scarring, vision deficits, or the need for corneal transplant.
Corneal Hydrops. Patient with marked corneal edema consistent with acute corneal hydrops. (Photo contributor: Kevin J. Knoop, MD, MS.)
Patients with corneal hydrops typically present with acute-onset photophobia and decreased visual acuity. Corneal edema can be appreciated on slit-lamp examination.
Corneal hydrops is typically self-limiting but requires ophthalmologic consultation for follow-up as an outpatient.
Treatments have not been shown to change the clinical sequelae of corneal hydrops but may shorten or relieve symptoms.
Corneal Hydrops. Patient presenting with conical protrusion and edema seen in the lateral view. (Photo contributor: Lawrence B. Stack, MD.)
Corneal Hydrops. Inferior conical protrusion and edema in left eye. Note the indentation (“V”-shaped) on the lower lid due to keratoconus (Munson sign). (Photo contributor: Lawrence B. Stack, MD.)