Corneal hydrops affects patients with keratoconus, usually patients who have very advanced or severe stages of keratoconus.
The cornea has 5 layers. From front to back: epithelium, basement membrane, stroma, Descemet's membrane, and endothelium. Each layer is critical to the health of the cornea.
In corneal hydrops, the fourth layer - Descemet's membrane splits or breaks. The reason this happens is because with advanced keratoconus, the cornea is getting steeper and steeper and steeper with time. When the cornea gets super steep, the Descemet's membrane can rupture, which leads to hydrops.
When Descemet's layer ruptures, the cornea cannot pump out the water within the cornea effectively, which leads to swelling or edema. You can usually see this as a large white spot like in the photo here:
The OCT imaging in black and white also confirms edema in the cornea, represented by the areas of black within the corneal scan.
There are several treatment options for hydrops. First, a hyperosmotic eye drop can be used called Muro 128. This hypersaline solution can help draw out excess liquid from the cornea, resulting in less corneal swelling.
If the patient is in pain, a cycloplegic such as atropine can also be used. Steroids, NSAIDs, and glaucoma drops are also commonly used.
In severe cases, a corneal specialist can insert a gas bubble into the anterior chamber to help seal Descemet's membrane.
The good news is that hydrops will usually resolve itself in a matter of weeks or months. If patients have severe keratoconus or very thin corneas, they must be monitored very carefully to prevent corneal perforation. This would be an ocular emergency.
After hydrops resolves and Descemet's membrane has patched itself up, the cornea will usually have a scar showing evidence that hydrops took place. Unfortunately this is permanent.
The good news is many of our patients are still successfully fit into scleral lenses to help improve their vision after hydrops have resolved.