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Bullous keratopathy
is the presence of corneal epithelial bullae, resulting from corneal
endothelial disease.
Bullous keratopathy is caused by edema of the cornea, resulting from failure of the corneal endothelium to maintain the normally dehydrated state of the cornea. Most frequently it is due to Fuchs' corneal endothelial dystrophy or corneal endothelial trauma. Fuchs' dystrophy causes bilateral, progressive corneal endothelial cell loss, sometimes leading to symptomatic bullous keratopathy by age 50 to 60. Corneal endothelial trauma can occur during intraocular surgery (eg, cataract removal) or after placement of a poorly designed or malpositioned intraocular lens implant, leading to bullous keratopathy. Bullous keratopathy after cataract removal is called pseudophakic (ie, if an intraocular lens implant is present) or aphakic bullous keratopathy (ie, if no intraocular lens implant is present).
Subepithelial fluid-filled bullae form on the corneal surface as the corneal stroma swells, leading to eye discomfort, decreased visual acuity, loss of contrast, glare, and photophobia. Sometimes bullae rupture, causing pain and foreign body sensation. Bacteria can invade a ruptured bulla, leading to a corneal ulcer.
The bullae and swelling of the corneal stroma can be seen on slit-lamp examination.
Treatment should be by an ophthalmologist and includes topical dehydrating agents (eg, hypertonic saline), intraocular pressure–lowering agents, soft contact lenses for some mild to moderate cases, and treatment of any secondary microbial infection. Corneal transplantation is usually curative.
Last full review/revision October 2008 by Melvin I. Roat, MD
Content last modified October 2008
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