Sudden Pain and Cloudy Vision With Keratoconus: What Acute Corneal Hydrops Is and What to Expect

Most keratoconus changes happen slowly. Acute corneal hydrops is the exception. It can turn a clear-enough eye into a painful, cloudy, light-sensitive one almost overnight, and it frightens patients who have never heard of it. Knowing what it is helps you act quickly and stay calm.

What happens in hydrops

According to EyeWiki, the American Academy of Ophthalmology’s clinical encyclopedia, acute corneal hydrops is an uncommon complication of corneal ectatic disorders such as keratoconus. A break forms in Descemet membrane, a thin layer at the back of the cornea, and fluid from inside the eye rushes into the cornea, causing sudden swelling.

How common it is, and who is at risk

• EyeWiki reports that hydrops occurs in between 0.2% and 2.8% of people with keratoconus.
• It is most common between ages 20 and 40, and males may have up to double the risk.
• Risk factors include eye rubbing, atopic disease such as eczema and allergies, Down syndrome, a steeper cornea and a prior episode of hydrops.

Symptoms

EyeWiki describes sudden decreased vision, light sensitivity and pain. Episodes are often spontaneous but can follow coughing, sneezing, nose-blowing, eye rubbing or strenuous exercise. In some people, hydrops is the first sign that they have keratoconus at all.

What usually happens next

EyeWiki notes that initial management is often conservative, because many cases resolve on their own within 2 to 4 months. Doctors commonly use drops to keep the eye comfortable and protected while the swelling clears. In selected cases, an eye surgeon may inject air or gas into the front of the eye to help the swelling settle faster, though EyeWiki notes this has not been shown to improve final vision. Scarring can remain afterward, so follow-up with a cornea specialist matters.

What you can do

• Do not rub your eyes. EyeWiki lists minimizing eye rubbing and allergen exposure as possible ways to lower risk.
• Treat itchy allergies with your doctor’s help instead of with your knuckles.
• If your eye suddenly becomes painful, cloudy and light-sensitive, call your eye doctor the same day.

Keratoconus patients with very steep corneas are sometimes also checked carefully at the back of the eye; for plain-language retina articles, see this retina education blog.

Hydrops is scary, but it usually settles with time and careful follow-up. The most important thing is not to wait at home with a suddenly white, painful eye.

Source: Acute Corneal Hydrops (EyeWiki, American Academy of Ophthalmology). This article is an educational summary written by Khanna Vision Institute and is not a substitute for medical advice.