Clinical Profile And Outcomes Of Acute Corneal Hydrops In Keratoconus: A Descriptive Analysis

Published 2026 - 44th Congress of the ESCRS

Reference: POCOR384 | Type: Poster | DOI: 10.82333/njg0-fk43

Authors: Dr Mariana Pires Garcia* ¹ , Dr Catarina Pestana Aguiar ¹ , Dr Pedro Cardoso Teixeira ¹ , Dr João Alves Ambrósio ¹ , Dr João Chibante Pedro ¹ , Dr Inês Almeida ¹

¹Ophthalmology Department,Unidade Local de Saúde de Entre Douro e Vouga, E.P.E.,Santa Maria da Feira,Portugal

Purpose

Acute corneal hydrops is an uncommon but severe complication of keratoconus, caused by a break in the Descemet membrane and corneal endothelium, allowing aqueous humor to enter the stroma. This leads to sudden corneal edema, acute visual impairment and may result in permanent corneal scarring requiring keratoplasty. With this study, we aim to describe the clinical profile, associated risk factors and outcomes of patients presenting with acute corneal hydrops in a major district public hospital in Portugal.

Setting

Cornea Service, Ophthalmology Department, Unidade Local de Saúde Entre Douro e Vouga, Portugal.

Methods

This retrospective case series included patients diagnosed with acute corneal hydrops between 2016 and 2026. Demographic data, including sex and age at diagnosis, were recorded. Clinical data included the form of presentation (emergency department or outpatient ophthalmology consultation), symptoms and visual acuity at diagnosis. Associated systemic conditions, such as Trisomy 21, history of atopy (asthma, allergic rhinitis, or allergic dermatitis) and others were collected from medical records. The need for surgical treatment and postoperative visual outcomes were also assessed.

Results

10 patients were included. Mean age at presentation was 37.8 ± 10.9 years, 80% were male. 90% of cases presented to the emergency department. Regarding comorbidities, 50% had Trisomy 21 and 40% had history of atopic disease. Obesity was present in 60% of cases and other cardiovascular risk factors, including hypertension and dyslipidemia, were also found in 60%. The most common presenting symptoms were ocular redness, pain and decreased vision. Visual acuity (VA) at presentation was severely reduced in all cases, with counting fingers or worse. Penetrating keratoplasty was later performed in 70% of eyes. Postoperative visual acuity improved in all transplanted patients, with a mean postoperative VA of 0.43 and one patient reaching 0.8.

Conclusions

In this case series, most patients were initially assessed in an emergency setting without prior diagnosis or follow-up, with acute corneal hydrops representing the first manifestation of keratoconus. Systemic conditions such as Trisomy 21, atopic disease, eye rubbing and obesity were frequently observed among these patients. Recognition of these risk factors, together with early identification of ectatic corneal disease and timely referral to specialized care, is essential to improve disease control and reduce the likelihood of this complication. Once the acute episode is established, appropriate follow-up and corneal transplantation may allow good visual recovery.