Hydrops And Keratoglobus : A Rare And Challenging Case

The purpose is to describe a rare case of acute keratoglobus complicated by corneal hydrops and to emphasize the clinical, imaging, and therapeutic challenges associated with this uncommon and potentially sight-threatening corneal ectasia.

Through this case, we aim to contribute to the limited literature available on acute presentations of keratoglobus and discuss practical management considerations.

This case was managed in the Department of Ophthalmology at Hassan II University Hospital, Fez, Morocco, a tertiary referral center for complex anterior segment pathologies.

A 55-year-old woman presented with a one-week history of painful red eye, sudden visual loss, and photophobia. She had a history of allergic conjunctivitis and chronic eye rubbing, with no relevant family history.

 Ophthalmologic examination revealed bilateral keratoglobus characterized by diffuse corneal thinning and globular protrusion. The right eye showed marked thinning with irregular astigmatism, while the left eye presented with acute corneal hydrops secondary to rupture of Descemet’s membrane and complete detachment of the endothelium–Descemet complex, confirmed by anterior segment OCT.

Systemic evaluation was unremarkable, with no features suggestive of connective tissue disorders. Corneal topography demonstrated bilateral diffuse thinning.

 Management included oral and topical intraocular pressure-lowering therapy, topical corticosteroids, intracameral SF6 gas injection, compressive sutures, and supine positioning.

Follow-up OCT showed partial reattachment of Descemet’s membrane, with residual corneal scarring. The patient was scheduled for keratoplasty for visual rehabilitation.

Keratoglobus is a rare, bilateral, non-inflammatory corneal ectasia characterized by diffuse thinning and globular protrusion. Its acute form, resulting from spontaneous or trauma-induced rupture of Descemet’s membrane, is exceptionally uncommon. Acute keratoglobus represents a therapeutic challenge due to the extreme corneal fragility, absence of standardized management protocols, and the frequent need for complex surgical intervention.