Acute hydrops is a well-known complication of keratoconus. It usually manifests as sudden onset loss of vision. Mostly presents in the pubertal age group. Allergic conjunctivitis associated with eye rubbing is the most substantial risk factor. Primary pathology being stromal lysis, which triggers the progression of cone, causing an undue stretch on Descemet Membrane, eventually resulting in its splitting and stromal imbibition of aqueous through these ruptures. Clinical signs are circum-cillary congestion and thick/edematous cornea with obscuration of the anterior segment. Conservative therapy delays wound healing; hence early surgical intervention is recommended globally for faster resolution of stromal edema. Long-standing corneal edema mounts to corneal perforation and neovascularisation of cornea. Compressive suture, non expansile intracameral gas injection, Deep anterior lamellar keratoplasty, and mini Descemet membrane keratoplasty are various management modalities reported in literature. Acute hydrops could be well prevented with early identification of progressive keratoconus and halting its progression.
Part of the book: Eyesight and Imaging