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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. Corneal endothelial trauma can occur during intraocular surgery (eg, cataract removal) or after placement of a poorly designed or malpositioned intraocular lens implant, promoting the development of bullous keratopathy. Fuchs' dystrophy causes bilateral, progressive corneal endothelial cell loss, sometimes leading to bullous keratopathy by age 50 to 60.
Subepithelial fluid-filled bullae form on the corneal surface and the corneal stroma swells, leading to eye discomfort, decreased visual acuity, loss of contrast, glare, and photophobia. Some bullae rupture, and bacteria can invade a ruptured bulla, leading to a corneal ulcer. The main symptom of rupture is moderate to severe pain.
The bullae and swelling of the corneal stroma can be seen on slit-lamp examination.
Treatment should be by an ophthalmologist and includes the use of dehydrating agents (eg, hypertonic saline), intraocular pressure–lowering agents, and soft contact lenses for some mild to moderate cases; corneal transplantation is usually successful.
Last full review/revision November 2005
Content last modified November 2005
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