Spontaneous bilateral corneal perforation of acute hydrops in keratoconus

To report an uncommon case of bilateral spontaneous corneal perforation in keratoconus.

Interventional case report.

A 63-year-old man with a long history of keratoconus (more than 30 years) experienced acute hydrops and corneal perforation in his right eye. One year later, he had the same clinical features in his left eye.

After initial treatment with cyanoacrylate glue and bandage soft contact lenses, therapeutic penetrating keratoplasty was performed with good visual outcome in both eyes.

Special attention should be paid to the possibility of spontaneous corneal perforation during acute hydrops in patients with severe corneal thinning, biomicroscopic findings of advanced disease, and high keratometry readings.