Hydrops… Steph Tweedie shares her experience:
Top photo – 21st December 2019
Middle photo – 26th December 2019
Bottom photo – 3rd January 2020
What Is Hydrops?
Corneal hydrops is an uncommon complication seen in people with advanced keratoconus or other corneal ectatic disorders, and is characterised by stromal edema due to leakage of aqueous humor through a tear in the Descemet’s membrane.
The patient presents with sudden onset decrease in vision, photophobia, and pain. Corneal thinning and ectasias combined with trivial trauma to the eye mostly by eye rubbing is considered as the underlying cause. With conservative approach self-resolution takes around 2 to 3 months. Surgical intervention is required in cases of non-resolution of corneal edema to avoid complications and for early visual rehabilitation. Intracameral injection of air or gas such as perflouropropane is the most common surgical procedure done.
Recent investigative modality such as anterior segment optical coherence tomography is an extremely useful tool for diagnosis, surgical planning, and postoperative follow up.
Sudden reduction in visual acuity
Contact lens intolerance
Gross stromal oedema with or without epithelial oedema
- usually over a clearly demarcated area
- Descemet’s membrane rupture may be visible
- periphery usually spared, except in pellucid marginal degeneration
Conservative management for acute corneal hydrops includes hypertonic sodium chloride to reduce epithelial edema, and cycloplegia for comfort.
Topical steroids are controversial, but we often employ them to reduce the inflammation and subsequent neovascularization that can accompany these episodes
UPDATE- Post hydrops check up- “Came out looking like I have a bionic eye (drops were used)” January 2020
At my appointment last Tuesday I was told to stop using steroid drops and just continue to use the lubricating drops which I’m using as I should be.” Keep going Steph! #kcfamily
What Happens Next?
Resolution of hydrops may improve the contact lens tolerance and visual acuity but most cases require keratoplasty for visual rehabilitation.
Hydrops can leave a residual scar and cause flattening of the cone. In KC the cone usually does not involve the central area, hence visual acuity can show some improvement after healing of the hydrops.
Corneal flattening may also improve the contact lens fitting.