What is Bullous Keratopathy?

Bullous keratopathy is the permanent swelling of the cornea resulting from damaged corneal endothelium. The inner corneal layer, the endothelium, maintains the clear and transparent state of the cornea by pumping excess fluid out of the cornea. When this layer is distorted due to various pathologies, aqueous humor enters the cornea, particularly the most superficial layers such as the epithelium and corneal stroma. Subepithelial fluid-filled small vesicles or bullae are formed on the corneal surface as the corneal stroma swells, which eventually leads to visual impairment, poor contrast, glare, and photophobia.

It can be caused by congenital corneal dystrophies, corneal endothelial trauma secondary to various surgical procedures, glaucoma, or inflammation after ocular surgery. Penetrating Endothelial Keratoplasty (PEK) is indicated in the treatment for bullous keratopathy.

Causes of Bullous Keratopathy

Bullous keratopathy is caused by failure of the corneal endothelium to maintain the usual dehydrated state of the cornea. With the advancement in cataract surgery techniques and intraocular lens implants, corneal complications are less common after cataract surgeries.

There are many reasons the corneal endothelium might get damaged, such as:

• Glaucoma and trauma secondary to glaucoma surgery
• Congenital endothelial dystrophies: Fuchs’ dystrophy, etc.
• Anterior chamber intraocular lens
• Infections
• Prolonged inflammation
• Corneal endothelial trauma: Intraocular surgery (cataract removal), malpositioned or poorly designed intraocular lens implant

Treatment of Bullous Keratopathy

Depending upon the stage and progression of the disease, an ophthalmologist may opt for treatment options ranging from eye drops and ointments to surgical procedures.

• Topical dehydrating agents: Hyperosmotic sodium chloride 5% drops and ointment.
• Soft contact lens to control the pain for mild to moderate cases.
• Intraocular pressure-lowering medications.
• Treatment of any secondary microbial infections.
• Surgical: Corneal transplant is the curative measure for advanced cases. Hence, an ophthalmologist may opt for a corneal transplant in which all the diseased part of the cornea gets replaced with healthy donor corneal tissues. Descemet’s stripping automated endothelial keratoplasty (DSAEK) and Descemet’s membrane endothelial keratoplasty (DMEK) are the most common types of surgical treatment.