Corneal Hydrops As A Presenting Symptom Of Corneal Ectatic Disease In A Young Patient: A Case Report

Published 2023 - 41st Congress of the ESCRS

Reference: PO0707 | DOI: 10.82333/szq5-6j74

Authors: Marta Sofia Rodrigues Correia* ¹ , Margarida Baptista ¹ , João Romana ¹ , Miguel Cordeiro ¹ , Carolina Bruxelas ¹ , Helena Prior Filipe ¹

¹Ophthalmology,Centro Hospitalar de Lisboa Ocidental,Lisbon,Portugal

With this work the authors aim to report a clinical case of a young patient with an acute episode of corneal hydrops (ACH) as a presenting sign of ectatic corneal disease.

Ophthalmology Emergency Room, Ophthalmology Department, Hospital de Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.

The authors review a case of a 12-year-old Caucasian male, who presented to the ophthalmology emergency department after being alerted that his left eye (LE) appeared “blue”. He denied ocular pain, photophobia, or subjective decrease in visual acuity (VA). No relevant personal or familial diseases were reported by the patient nor the parents. Demographic and clinical data were collected from consulting the medical records. The investigation was completed by anterior segment optical coherence tomography (Heidelberg Spectralis® AS-OCT) and corneal Scheimpflug tomography (Oculus Pentacam®).

The ophthalmologic examination revealed a best corrected VA of 1.0 in the right eye (RE) and hand movements in the LE. The IOP was 10 mmHg in the RE and 3 mmHg in the LE. Slit-lamp (SL) biomicroscopy of LE showed severe diffuse bullous oedema of the central corneal stroma due to acute hydrops. SL evaluation and fundus observation of the RE were unremarkable. The AS-OCT and Pentacam® confirmed a rupture in central Descemet’s membrane and bullous edema throughout all corneal layers. Hypertonic solution, topical beta-blocker and atropine were initiated. 4-weeks after presentation, ST evaluation and AS-OCT revealed central corneal scarring with complete resolution of the corneal oedema of the LE and mild corneal thinning of the RE.

ACH occurs in an estimated 0,2 to 2,8% keratoconus (KCN) patients. It is characterized by a rupture of the Descemet’s membrane and an influx of aqueous humor into the corneal stroma and epithelium. In healthy children, eye rubbing is considered a major predisposing factor for progression. The young age and a scarcely normal ophthalmologic exam of the fellow eye in this patient is a remarkably unusual feature, as acute corneal hydrops typically occurs in more advanced disease. In cases of early onset, it is reported a greater rate of disease progression, more frequent advanced KCN and greater need for corneal transplantation. Therefore, is of the outmost importance a rigorous follow-up of young patients with these manifestations.