MEDICAL TREATMENT OF CORNEAL HYDROPS REVEALING UNRECOGNIZED KERATOCONUS ASSOCIATED WITH DOWN SYNDROME: A CASE REPORT

Corneal hydrops is an acute stromal oedema secondary to the rupture of Descemet's membrane, which can be spontaneous or post-traumatic, generally complicating keratoconus. Its diagnosis is essentially clinical, and its therapeutic management can be medical and surgical, it is a rare complication which can engage the anatomical and functional prognosis of the eye.

     The aim of our case is to highlight the importance of medical treatment as the first step in the management of corneal hydrops.

      We present the case of a 21-year-old female patient, carrier of trisomy 21, with a history of atopic terrain, who presented with a sudden drop in her visual acuity with the appearance of a corneal opacity in her left eye.

The patient underwent a complete ophthalmological examination including measurement of distance and near visual acuity with and without correction, anterior and posterior segment biomicroscopic examination, supplemented by anterior segment OCT, corneal ultrasonic pachymetry, and corneal topography of the adelphic eye.

 The ophthalmological examination showed visual acuity in the left eye with light perception (+), anterior blepharitis, conjunctival hyperhaemia, corneal opacity with oedema and diffuse thickening suggestive of corneal hydrops, the rest of the examination was inaccessible.

     The examination of the adelphic eye revealed a visual acuity of 6/10, a positive Munson's sign, Vogt's striae, a posterior subcapsular cataract, the fundus was without particularities

     A corneal topography performed on the OD showed keratoconus with pachy min at 349 and Kmax at 54.2.

     A local and general hypotonising treatment was instituted (acetazolamide 250mg ½ tablet *3/d with potassium supplementation, brimonidine one drop *2/d, a combination of beta-blocker + dorzolamide one drop*2/d), a local corticosteroid therapy based on dexamethasone one drop *6/d with gradual degression, associated with artificial tears and a local antihistamine.

     The clinical evolution was favourable after one month of well conducted treatment giving an improvement of the visual acuity to 5/10, disappearance of the oedema and the corneal opacity.

  Early and appropriate medical treatment remains of major importance in the management of corneal hydrops, as it can sometimes restore good anatomical and functional integrity to the eye without recourse to other more invasive methods.