Acute hydrops is a medical condition characterized by a sudden accumulation of fluid within the cornea, the clear, dome-shaped front surface of the eye. This condition is an uncommon complication of underlying corneal disorders, particularly keratoconus. Prompt intervention is important to manage the condition and preserve vision.
Understanding Acute Hydrops
Acute hydrops involves the sudden swelling of the cornea. This occurs when a tear develops in Descemet’s membrane, a thin, innermost layer of the cornea, allowing fluid from inside the eye to leak into the corneal stroma, the middle layer. This leakage of aqueous humor causes the cornea to swell and become cloudy or hazy, often appearing as a whitish spot on the eye.
Corneal swelling leads to noticeable symptoms. Individuals may experience a sudden decrease in vision, often described as blurry or distorted, along with severe eye pain that can be constant and sharp. Other common signs include redness of the affected eye, extreme sensitivity to light, and increased tear production. These symptoms can last for several weeks.
Causes of Acute Hydrops
Acute hydrops is associated with corneal ectasias, progressive eye disorders that cause the cornea to thin and bulge outwards. The most common underlying condition is keratoconus, where the cornea develops a cone-like shape, making it more susceptible to this type of swelling. Other corneal ectasias that can lead to acute hydrops include pellucid marginal degeneration and keratoglobus.
The tear in Descemet’s membrane, which allows fluid leakage, can occur spontaneously. However, activities that temporarily increase pressure within the eye, such as vigorous eye rubbing, forceful sneezing or coughing, or strenuous exercise, may precede the event. This suggests that mechanical stress on an already weakened cornea may contribute to the membrane rupture. Individuals with more severe keratoconus, a younger age of diagnosis, and a history of eye rubbing are at a higher risk of developing acute hydrops.
Diagnosis and Treatment
Diagnosing acute hydrops involves a thorough eye examination by an eye care provider. The provider assesses the sudden vision loss, eye pain, and light sensitivity reported by the patient. During the examination, characteristic corneal swelling and cloudiness will be observed.
Advanced imaging techniques, such as anterior segment optical coherence tomography (AS-OCT), are used to confirm the diagnosis and visualize the tear in Descemet’s membrane. This imaging also helps in surgical planning and monitoring the healing process. Treatment is conservative, allowing the tear in Descemet’s membrane to reattach and the fluid in the stroma to reabsorb naturally, which can take two to three months.
Supportive care includes prescribing eyedrops to reduce pain and inflammation and promote healing. In some cases, a bandage contact lens may be placed over the eye to provide comfort during the initial healing phase. For cases where corneal edema does not resolve or for faster visual rehabilitation, surgical interventions may be considered. A common procedure involves an intracameral injection of air or gas, such as perfluoropropane, into the eye. This bubble exerts pressure against Descemet’s membrane, helping to close the tear and accelerate fluid reabsorption.
Prognosis and Ongoing Management
The outlook for individuals experiencing acute hydrops varies, depending on the underlying corneal condition, the severity of fluid accumulation, and the timeliness of medical intervention. While some cases may resolve with conservative management, the episode can still lead to a residual scar in the cornea where the swelling occurred. This scarring can permanently affect vision, potentially making it difficult to achieve clear vision even with specialized contact lenses.
Ongoing medical follow-up is needed after the initial treatment of acute hydrops. Regular monitoring allows eye care providers to assess the healing process, manage any lingering symptoms, and address potential long-term complications such as significant scarring. Depending on the visual outcome, individuals may require continued use of corrective lenses or may be considered for a corneal transplant to improve vision.