UNILATERAL CORNEAL HYDROPS ASSOCIATED WITH VERNAL KERATOCONJUNCTIVITIS AS A REVEALING SIGN OF KERATOCONUS: ABOUT THREE CASES

To report cases of unilateral corneal hydrops associated with vernal conjunctivitis as a presenting sign of keratoconus.

Corneal hydrops corresponds to an aqueous infiltration of the cornea following a breach in the descemet membrane. It usually complicates keratoconus but it can occur on pellucid marginal degeneration, keratoglobus or other. The treatment of acute hydrops has improved significantly in recent years.

We report a series of 3 patients with acute hydrops with no known underlying etiology. Our patients were enrolled in the ophthalmology department A at the hospital of specialties in Rabat. All patients initially consulted for a sudden decrease in unilateral visual acuity. They underwent a complete ophthalmological examination including a measurement of far and near visual acuity with correction, a measurement of eye tone and a biomicroscopic examination of the anterior and posterior segment with the realization of an eye fundus, pachymetry, corneal topography, and an Optical coherence tomography of the anterior segment.

The average age of our patients is 19.5 years. These are 2 men and 1 woman. All of our patients are being monitored for allergic conjunctivitis. Patients were seen urgently for pain and photophobia with worsening loss of visual acuity. Visual acuity on the day of admission was less than 1/10 in all cases. Slit lamp examination found a perikeratic circle associated with edema and corneal thickening. After a bilateral and complete clinical examination, the diagnosis of hydrops complicating keratoconus was retained in all cases. All of our patients received initial medical treatment consisting of lubricants, cycloplegia and systemic anti-hypertensive drugs (oral acetazolamide). One patient received an intracameral injection of SF6 gas. Regression of irritative signs and edema was obtained in a few days in two patients with an improvement in visual acuity greater than 3/10, the third was placed on the waiting list to benefit from a transfixing keratoplasty.

Corneal hydrops is a rare complication of keratoconus, but it marks a turning point in the course of the disease. Hereditary and environmental factors may contribute to the etiology of keratoconus and corneal hydrops.