**Abstract**

Acute hydrops is a well-known complication of keratoconus. It usually manifests as sudden onset loss of vision. Mostly presents in the pubertal age group. Allergic conjunctivitis associated with eye rubbing is the most substantial risk factor. Primary pathology being stromal lysis, which triggers the progression of cone, causing an undue stretch on Descemet Membrane, eventually resulting in its splitting and stromal imbibition of aqueous through these ruptures. Clinical signs are circumcillary congestion and thick/edematous cornea with obscuration of the anterior segment. Conservative therapy delays wound healing; hence early surgical intervention is recommended globally for faster resolution of stromal edema. Long-standing corneal edema mounts to corneal perforation and neovascularisation of cornea. Compressive suture, non expansile intracameral gas injection, Deep anterior lamellar keratoplasty, and mini Descemet membrane keratoplasty are various management modalities reported in literature. Acute hydrops could be well prevented with early identification of progressive keratoconus and halting its progression.

**Keywords:** acute hydrops, keratoconus, compressive sutures, intracameral gas, ocular allergy

## **1. Introduction**

#### **1.1 Epidemiology**

Acute hydrops is a well-known complication of progressive keratoconus. It has also been reported in other noninflammatory ectatic disorders such as pellucid marginal degeneration and keratoglobus. The incidence of acute hydrops is minimal but varies according to race. A 2011 UK census reported higher number of cases among the South Asian and Black ethnic groups, compared with that in the general population. The reported incidence rates among the white, South Asian, and black population are 0.07/100,000, 0.32 /100,000, and 0.37/100,000, respectively [1]. According to numerous studies, the trend in acute hydrops Incidence among patients with keratoconus has been shown to be decreasing; Tuft et al. and Amsler M et al. reported the prevalence of acute hydrops as 2.6% and 2.8%, respectively [2, 3]. Acute hydrops can occur at any age but is commonly reported in individuals aged between 20 and 30 years, whereas the broad age range is 10 to 47 years. It has a significant gender disparity; men are more susceptible to this condition compared with women, with a ratio of 1.2:1 according to the Auckland Keratoconus Study [4], 3:1 according to a UK prospective study [1], and 2.9:1 according to an American study [5].
