Acute keratoconus (corneal hydrops)

Chronic keratoconus often (about 10% of all cases) leads to a serious complication – acute keratoconus. It is characterized by the sudden appearance of corneal stromal edema, which occurs due to the local extensive rupture of the descemet shell and penetration of moisture into the stromal layers from the anterior chamber of the eye.

The symptoms

Significant edema of the corneal stroma entails a sharp and significant deterioration of vision, which was low and before the manifestation of acute keratoconus. When this condition occurs, visual acuity is defined as light perception with proper light projection. Almost all patients in this case is determined by the corneal syndrome.

Diagnostics

Biomicroscopy of the eye allows you to see a sharp swelling of all layers of the cornea, while its tissue is very much bulging and thinning. Sometimes it is possible the occurrence of descemetocele with the threat of perforation. But it should be noted that the rupture of the cornea in the case of acute keratoconus is very rare. Although due to inadequate behavior the real probability of perforation increases in patients with down syndrome or with serious mental disorders.

Treatment of acute keratoconus

Some authors believe that the state of acute keratoconus does not require active treatment, because it can pass spontaneously.

In the absence of treatment of corneal edema, the swelling of the cornea independently passes within 4-5 months. Upon completion of the relief of the pathological process in acute keratoconus, the cornea somewhat flattens due to the formation of turbidity and local closure of the rupture area of the descemet membrane. As a result of this flattening of the cornea in patients slightly improved vision, and often again there is the possibility of using contact correction.

Many experts in acute keratoconus suggest the use of active surgical tactics-the introduction of autologous blood into the anterior chamber of the eye, bandage strengthening of the cornea and other techniques. A number of surgeons talking about the possibility and even the advisability with the state of the implementation of the emergency penetrating keratoplasty. Other doctors recommend active drug therapy for the treatment of acute keratoconus. Conducting biomicroscopy in the cold period in patients who have undergone acute keratoconus, makes it possible to accurately identify the zone of rupture of the descemet shell and the presence of a rough scar of the cornea passing through all its layers. Biomicroscopic picture after rupture of descemet's membrane in the case of acute keratoconus in the English ophthalmic literature is called the symptom of "fish mouth".

In the absence of treatment of acute keratoconus, the swelling of the cornea independently passes within 4-5 months. Upon completion of the relief of the pathological process in acute keratoconus, the cornea somewhat flattens due to the formation of turbidity and local closure of the rupture area of the descemet membrane. As a result of this flattening of the cornea in patients slightly improved vision, and often again there is the possibility of using contact correction.

I must say that acute keratoconus is often mistakenly diagnosed as keratitis. In this case, medical treatment is prescribed, which can aggravate the condition of the patient's eye.

In the available ophthalmic literature references to the repetition of corneal hydrops in one eye is not found. However, we twice had to face a repetition of acute keratoconus in our clinical practice: in the first case in a patient with down syndrome – after three years, and in the second case - after 25 years (in the discharge epicrisis of the patient was recorded transferred for the first time acute keratoconus).