**8. Complications**

Acute hydrops commonly resolves spontaneously over a period of 4–8 weeks; however, it can be delayed because of large DM deficit or poor functionality of the corneal endothelial cells [49].

The risk of corneal perforation in cases of extreme penetration of fluid into the anterior stromal space is also present, which results in the formation of the epithelial bullae [50]. Any trivial trauma or ocular rubbing causes the rupture of the bullae, which may lead to shallowing of an anterior chamber and the formation of an anterior synechiae. Upon healing, it forms a dense vascularized corneal scar with extremely poor prognosis [51].

Corneal vascularization can be accentuated with a delay in the process of corneal edema reduction. Long-term cornea edema is associated with a risk of the release of vascular endothelial growth factors that induces corneal vasculogenesis from the peripheral corneal vessels, eventually leading to the formation of a vascularized corneal scar [51].

Bullous rupture of the corneal surface exposes raw stroma to the tear film and ocular commensals. Poor hygienic practices may lead to infectious keratitis [52]. Mostly bacterial keratitis has been reported; however, fungal keratitis has also been reported in the tropical countries. In developing countries such as India, the use of over-the-counter topical corticosteroids without clinical consultation is rampant that has led to the development of debilitating infectious keratitis [53].
