Acute corneal hydrops: a case report including confocal and histopathological considerations

This is a case report of corneal hydrops associated with keratoconus with a review of current literature pertaining to diagnosis, histopathology, and treatment options. A 30-year-old African American male presented to the University Eye Institute with acute unilateral pain, redness, and visual impairment. His symptoms, clinical presentation and past diagnosis of keratoconus confirmed his condition to be acute corneal hydrops (CH). The condition was closely followed utilizing topical treatment including hyper-osmotic (Muro 128) and non-steroidal anti-inflammatory agents (Acular and Voltaren). After 4 months, the patient's condition resolved but subsequent corneal scarring resulted. Corneal ectasia in patients with keratoconus may progress into acute rupture of the posterior limiting lamina (PLL) and the endothelium, resulting in CH, which may manifest as an area of edematous and opacified cornea lasting up to 4 months in duration. Acute complications such as CH seldom occur. Histopathology and confocal microscopy can be used to help visualize and understand CH on a cellular level. After regeneration of the corneal structures, central scarring may limit visual acuity and necessitate a corneal transplant.