Bullous keratopathy accompanying essential iris atrophy: response to lowered intraocular pressure

We present a patient with essential iris atrophy who was normotensive and yet had corneal edema and bullous keratopathy which cleared upon lowering the intraocular pressure. It is proposed that in this patient the endothelial functional status was so compromised that it could not handle the amount of fluid driven into the cornea by a normal intraocular pressure. A more favorable balance between intraocular pressure and endothelial functional status was obtained by lowering the intraocular pressure with acetazolamide and timolol.