a b s t r a c t

A 21-year old female presented to the emergency department with an abnormal appearance of her left eye after trivial trauma the previous day. A protruding, opaque appearing area was noted on the left cornea. The patient underwent visual acuity testing, fluorescein staining with slit lamp examination revealing a conical corneal pro- trusion with corneal stromal edema suggestive of corneal hydrops. Corneal hydrops is a rare complication of keratoconus and various corneal ectasias where aqueous humor can leak into the corneal stroma causing edema and protruding pockets of fluid. Treatment is based on treating the underlying keratoconus or corneal ectasia in addition to cycloplegics, topical corticosteroids, topical antibiotics, and topical hypertonic saline.

(C) 2019

1. case presentation“>Case presentation

A 21-year-old female presented with an abnormal appearing left eye after sustaining a Minor injury the day prior to the af- fected eye. The injury was the result of her jacket zipper inadver- tently striking her left eye. Upon awakening, she noticed an abnormally appearing eye characterized by a protruding area that was described as “cloudy” appearing. She denied the presence of pain, visual changes, discharge, tearing, or photosensitivity. She denied any previous Ocular trauma, procedures, or use of contact lenses. She did wear corrective glasses since adolescence and had constant changes to her prescription secondary to declining visual acuity. Visual acuity was 20/200 OS (left eye), 20/70 OD (right eye), with unremarkable fluorescein staining. Slit lamp ex- amination revealed a conical protrusion from the cornea and the presence of a focal, opaque area of edema of the corneal stroma that was markedly elevated (Fig. 1, Fig. 2).

1. Discussion

The case was discussed with ophthalmology and the patient was diagnosed with presumed corneal hydrops secondary to un-

* Corresponding author at: Department of Emergency Medicine, 1505 W. Sherman Ave, Vineland, NJ 08360, USA.

E-mail address: [email protected] (M. Durrani).

diagnosed keratoconus. The patient was discharged with close ophthalmology follow up with management that included a top- ical antibiotic and a cycloplegic medication along with lubri- cants. The diagnosis was confirmed during subsequent ophthalmology follow up. Keratoconus is a condition of progres- sive corneal degradation manifesting as asymmetric localized corneal thinning with corneal protrusion which can lead to ir- regular astigmatism and myopia as well as corneal scarring [1]. The incidence of keratoconus is noted to be 8.8-54.4 per 100,000 with the mean age of onset noted to be in the second decade of life [2]. Corneal hydrops is a rare complication of keratoconus and other corneal ectasias, where there is a tear in Descemet membrane allowing for leakage of aqueous humor into the stroma causing intra-stromal edema and fluid filled pockets [2-4]. A history of eye rubbing and individuals with se- vere allergic eye disease have been associated with developing corneal hydrops [2]. It presents clinically with pain, photopho- bia, and reduced visual acuity, although clinical features can range from asymptomatic to marked symptoms [3]. Treatment includes use of topical antibiotics, along with topical hypertonic saline to help reduce stromal edema, topical corticosteroids to halt neovascularization and reduce inflammation, as well as cycloplegic medications to reduce pain in addition to treatment of the underlying keratoconus [2].

Declaration of Competing Interest

The authors declared that there is no conflict of interest.

https://doi.org/10.1016/j.ajem.2019.11.028

0735-6757/(C) 2019

Fig. 1. Focal elevated opaque area of edema of the corneal stroma (white arrow).

Fig. 2. Focal elevated opaque area of edema of the corneal stroma (white arrow).

References

1. Romero-Jimenez M, Santodomingo-Rubido J, Wolffsohn J. Keratoconus: a review. Contact Lens Anterior Eye 2010;33(4):157-66.
2. Fan Gaskin J, Patel D, McGhee C. Acute corneal hydrops in Keratoconus-new perspec- tives. Am J Ophthalmol 2014;157(5):921-928.e1.
3. Sharma N, Vajpayee R, Maharana P. Acute corneal hydrops in keratoconus. Indian J Ophthalmol 2013;61(8):461.
4. Parker J, Birbal R, van Dijk K, et al. Are Descemet membrane ruptures the root cause of corneal hydrops in keratoconic eyes? Am J Ophthalmol 2019.