Bullous keratopathy

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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W8MD medical weight loss NYC and sleep center NYC

Bullous keratopathy
Corneal edema in bullous keratopathy
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Corneal edema, blurred vision, eye pain, photophobia
Complications	Corneal ulcer, infection, vision loss
Onset	Gradual
Duration	Chronic
Types	N/A
Causes	Fuchs' dystrophy, cataract surgery, eye trauma
Risks	Age, genetic predisposition, eye surgery
Diagnosis	Slit-lamp examination, corneal pachymetry
Differential diagnosis	Keratoconus, corneal dystrophy
Prevention	N/A
Treatment	Hypertonic saline, bandage contact lens, corneal transplant
Medication	N/A
Prognosis	Variable, depends on treatment
Frequency	Common in older adults
Deaths	N/A

A condition affecting the cornea of the eye

Introduction

Bullous keratopathy is a pathological condition of the cornea characterized by the formation of fluid-filled blisters, or bullae, on the corneal surface. This condition often results from endothelial cell dysfunction, leading to corneal edema and subsequent visual impairment.

Pathophysiology

The cornea is composed of several layers, with the corneal endothelium playing a crucial role in maintaining corneal transparency by regulating fluid balance. In bullous keratopathy, damage to the endothelial cells disrupts this balance, causing fluid accumulation in the stroma and the formation of bullae on the epithelium.

Causes

Bullous keratopathy can arise from various causes, including:

• Fuchs' dystrophy
• Surgical trauma, particularly following cataract surgery
• Glaucoma
• Corneal transplant rejection

Symptoms

Patients with bullous keratopathy may experience:

• Decreased visual acuity
• Pain and discomfort due to ruptured bullae
• Photophobia
• Foreign body sensation

Diagnosis

Diagnosis is primarily clinical, supported by slit-lamp examination revealing corneal edema and bullae. Additional tests such as specular microscopy can assess endothelial cell density.

Treatment

Treatment options aim to relieve symptoms and restore corneal clarity. These include:

• Hypertonic saline drops or ointments to reduce edema
• Bandage contact lenses for pain relief
• Corneal transplantation procedures, such as Descemet's stripping endothelial keratoplasty (DSEK) or Descemet's membrane endothelial keratoplasty (DMEK)

Prognosis

The prognosis for bullous keratopathy varies depending on the underlying cause and the success of treatment interventions. Surgical options like endothelial keratoplasty have improved outcomes significantly.

Prevention

Preventive measures focus on minimizing surgical trauma during ocular procedures and managing conditions like glaucoma effectively to reduce the risk of endothelial damage.

See also

• Corneal dystrophy
• Keratoconus
• Ophthalmology