What is bullous keratopathy?
Bullous keratopathy is a pathological condition that occurs in the cornea.
The endothelium is a single layer of cells on the inner surface of the cornea that faces the anterior chamber. In a healthy cornea, endothelial cells keeps the tissue from absorbing excess fluid, pumping the fluid back into the aqueous humor (see diagram below).
In bullous keratopathy, the endothelium cells suffer mortality or damage by some reason, such as Fuchs’ dystrophy or trauma occurring during cataract or glaucoma surgery. The damaged endothelium is not able to pump fluid properly. The cornea becomes permanently swollen and bullae (blister-like formations) occur.
What are the symptoms of bullous keratopathy?
Bullous keratopathy can result in eye discomfort, pain when looking at bright lights, and significant blurring of vision. The bullae can rupture and further impair vision. The rupturing of bullae can cause severe pain, often with the sensation of a foreign object trapped in the eye.
What causes bullous keratopathy?
The main causes of bullous keratopathy have changed over the last two decades. Twenty years ago, the most common reason for bullous keratopathy was complications from cataract surgery, with or without problems from lens implants. Older lens implant designs very occasionally damaged the cornea. Over the past 20 years, cataract surgery techniques and lens implant designs have improved dramatically; corneal problems are much less of an issue after cataract surgery. One of the most common reasons now for developing bullous keratopathy is from problems related to glaucoma surgery.
How is bullous keratopathy treated?
Treatment can include:
- Salty eye drops (5% sodium chloride) and salty ointments are used to draw the excess fluid from the cornea
- Bandage contact lenses to reduce discomfort
- Glaucoma medications to reduce the pressure and flow of fluid into the cornea
- Surgical procedures to replace the damaged tissue. The most common types of surgical treatment are Descemet’s stripping endothelial keratoplasty (DSEK) and Descemet’s membrane endothelial keratoplasty (DMEK).
