4 Things to Know About Corneal Hydrops

Corneal hydrops is a serious complication of advanced keratoconus. At Insight Vision Optometry, Las Vegas, our specialty cornea team helps patients understand, manage, and recover from this condition. If you or a loved one has keratoconus, knowing the warning signs of corneal hydrops can help you act quickly when it matters most.

How Does Keratoconus Affect the Cornea?

Keratoconus is a progressive corneal disease that changes both the thickness and shape of the cornea. As the condition advances, the cornea becomes thinner and steeper, particularly in its central and lower portions. These changes can be detected with corneal topography or corneal tomography, which map the shape and thickness of the cornea in detail.

In early stages, keratoconus may produce only mild corneal changes that are detectable on imaging but cause minimal symptoms. As the disease progresses, however, the corneal distortion becomes more pronounced, leading to increasingly blurred and distorted vision. The progressive thinning and steepening can also place significant mechanical strain on the deeper layers of the cornea.

What Causes Corneal Hydrops in Keratoconus?

Corneal hydrops occurs when there is a break in Descemet’s membrane, one of the deepest layers of the cornea. Under normal conditions, Descemet’s membrane is quite resilient, but the extreme thinning and steepening caused by advanced keratoconus can subject this layer to more pressure than it can withstand.

When a break develops in Descemet’s membrane, aqueous fluid from inside the eye rushes into the corneal tissue, causing rapid and significant swelling. This process can progress quickly once it begins. It is important to understand that most individuals with keratoconus will never develop corneal hydrops. It occurs primarily in cases of advanced disease where significant corneal thinning is present.

What Are the Symptoms of Corneal Hydrops?

Corneal hydrops typically produces sudden, noticeable symptoms in one eye. The most common signs include:

• Sudden onset of significantly blurred vision in one eye
• Eye pain that may range from moderate to severe
• Visible cloudiness or whitening of the cornea
• Eye redness, irritation, and tearing
• Distorted vision and light sensitivity

Because the cornea is one of the most sensitive tissues in the body, these symptoms tend to be quite pronounced and difficult to ignore. If you experience sudden severe eye pain, significant vision loss, or notice a white cloudy area developing on your cornea, seek emergency eye care immediately. In rare cases, extreme corneal thinning can lead to perforation, which is a medical emergency requiring urgent treatment.

How Is Corneal Hydrops Treated?

Treatment for corneal hydrops focuses on reducing corneal swelling, managing pain, and protecting the eye while healing occurs. The primary treatment is Muro 128, a hypertonic saline eye drop used multiple times per day to draw excess fluid out of the swollen corneal tissue. This drop is available over the counter at most pharmacies, though it is sometimes kept behind the counter.

Additional treatments may include:

• A dilating eye drop to prevent the iris from moving and constricting, which can reduce pain
• A prescription anti-inflammatory eye drop for pain management
• A glaucoma eye drop if intraocular pressure is elevated
• Preservative-free artificial tears for comfort

In severe cases where the cornea does not heal adequately on its own, surgical intervention may be necessary. This can involve placing an air or gas bubble inside the eye to help push the corneal layers back together, or in the most advanced cases, a corneal transplant to replace the damaged tissue. Recovery time varies from patient to patient, and follow-up care is essential to monitor healing and adjust treatment as needed.

What Should Keratoconus Patients Watch For?

If you have been diagnosed with keratoconus, the best way to reduce your risk of complications like corneal hydrops is to follow your doctor’s recommended monitoring schedule and treatment plan. Corneal cross-linking, when appropriate, can strengthen the cornea and slow disease progression. Avoiding eye rubbing is also important, as repeated rubbing can accelerate corneal thinning.

Regular follow-up visits allow your doctor to track any changes in corneal shape and thickness and intervene early if the disease is progressing.

Schedule a Keratoconus Evaluation

Dr. Stephanie Woo, OD, FAAO, FSLS, Dr. Nathan Schramm, OD, FSLS, FBCLA, and Dr. Thanh Mai, OD, FSLS specialize in keratoconus management, corneal disease evaluation, and specialty contact lens fitting. If you have keratoconus and want to stay ahead of potential complications, contact Insight Vision Optometry, Las Vegas at 702-747-4070 or visit www.insightvisionlv.com to schedule an appointment.