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 keep the tissue from absorbing excess fluid, pumping the liquid back into the aqueous humor (see diagram below).
In bullous keratopathy, the endothelial cells suffer mortality or damage for 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, further impairing vision. The rupture of bullae can cause severe pain, often accompanied by the sensation of a foreign object being trapped in the eye.
What causes bullous keratopathy?
The leading 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 undergone significant improvements, resulting in corneal problems being much less of an issue following cataract surgery. One of the most common reasons for developing bullous keratopathy is issues 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 are used 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).
