On the basis of this patient's ocular history (ie, ocular rubbing and allergies), acute onset of pain, and presence of corneal edema with bullae, the correct diagnosis is acute corneal hydrops. Acute corneal hydrops are sequelae of a select few acquired ectasias,[1,2,3,4] including keratoconus, pellucid marginal degeneration, Terrien marginal degeneration, and post-refractive surgery ectasia. These degenerations can contribute to strain on the Descemet layer of the cornea. Hydrops are described as an acute break in the Descemet layer that causes an influx of aqueous humor into the corneal stroma.[4,5] The prevalence of acute hydrops is relatively low at 3% in keratoconus, but it is strongly associated with ocular rubbing and allergies.
Iridocorneal endothelial syndrome is more prevalent in young women and presents with iris abnormalities, painful corneal edema, and glaucoma, which this patient did not have.
Bullous keratopathy can be a sequela of trauma or surgery, usually cataract extraction. This patient did not have a history of ocular trauma or surgery.
Fuchs endothelial dystrophy is the most common endothelial dystrophy. It presents with bilateral guttata, thickened areas of Descemet membrane that lead to corneal edema. It can be relatively painless in the early stages. This patient had no endothelial findings to suggest a dystrophy.
Bacterial keratitis is a risk factor in all contact-lens wearers. This condition will cause discharge and corneal thinning with slight surrounding edema, but not thickening as was seen in this patient.
Medscape Optometry © 2016
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: A Cloudy and Painful Eye - Medscape - Sep 08, 2016.