Acute Corneal Hydrops In A Young Patient With Down Syndrome.

Published 2022 - 40th Congress of the ESCRS

Reference: PO039 | Type: Case report | DOI: 10.82333/ree8-v059

Authors: Mina Abdelmseih* ¹

¹ARTEMIS Augenkliniken, AMVZ,Hoyerswerda,Germany

Acute corneal hydrops is characterized by marked stromal edema due to a tear in Descemet's membrane (DM) which permits aqueous to enter the corneal stroma and epithelium. The Purpose of this case study is to present a unique case of severe acute corneal hydrops with keratoconus associated with Down syndrome leading to unilateral severe vision loss after excluding the conventional differential diagnosis.

ARTEMIS Augenkliniken, Department of Ophthalmology at AMVZ, Hoyerswerda.

A 16-year-old Indian male presented with photophobia and a central loss of vision in his left eye 3 days ago. He has a positive history of Down syndrome associated with Keratoconus. The best corrected visual acuity (BCVA) for far and near was unable to be tested because of his sever mental retardation. The right cornea was clear, and the left cornea showed marked edema and central conical protrusion.

Color photography on the left eye detected corneal edema, bullae, and conical protrusion.Pentacam of the right eye showed an early stage of Keratoconus and of the left eye revealed marked increase in the corneal thickness. Anterior Chamber OCT Scan of the left eye revealed bullae edema but tear in DM was unable to photograph because patient was uncooperative during the investigation.

Conservative treatment includes sodium chloride, cyclopentolate eye drops, combination of brimonidine and timolol with an artificial lubricant eye drops for symptomatic relief. A contact lens could not be used because the patient was uncooperative. Intracameral C3F8 gas injection was recommended to speed the recovery if there was no improvement with the medical treatment.

Gradual improvement in 4 weeks but extensive residual scarring and corneal irregularities were the cause of reduced visual acuity. Penetrating Keratoplasty (PK) was discussed but it was difficult because of low economic status and his mental retardation.

Acute corneal hydrops should be considered one of the important eye features for the diagnosis of Down syndrome. Patients and their family should be warned of the eye rubbing. Treatment could be conservative or interventional, including intracameral injections and Penetrating Keratoplasty. New treatments such as compressive sutures and tissue adhesive should be considered.

We believe that there is no establishing approach to deal with a challenging problem like acute hydrops in down’s syndrome patient with severe mental retardation. Educational programs for patients, family and doctors are necessary. Moreover, routine screening could be the most important method to discover the disorders earlier and may help prevent future complications.