**9. Differential diagnosis**

Penetrating ocular trauma may mimic acute hydrops; however, it has a recent background history of trauma and entry wound [54].

Calotropis keratitis commonly seen in the Indian subcontinent seen after accidental fall of whitish fluid while plucking the flower of the plant [55]. It may be localized or diffused and mostly presents as emergency having a perfectly normal vision before the fall. Upon slit lamp examination, a typical DM folds with the corneal edema are visible, and no breach in the continuity of DM is detected.

Post-herpetic endothelial dysfunctions are seen typically after an episode of herpetic keratitis or most likely after herpes zoster ophthalmicus. Clinically, it is seen as the localized corneal edema with pigment dusting of the endothelium and the presence of sectoral iris atrophy in case of herpes zoster [56, 57].

CMV keratitis is another rarely seen condition of the cornea that can be considered for the differential diagnosis of acute hydrops, and it typically manifests as a focal corneal edema and appears as a coin-shaped lesion [58].

Nuclear fragment retention after cataract surgery is a rare but a significant differential diagnosis, which manifests as on- and off-focal corneal edema mostly in the inferior quadrant. A careful clinical examination of an anterior segment reveals the presence of nuclear fragments and a positive history of recurrent anterior uveitis [59].

Bullous keratopathy due to Fuchs endothelial corneal dystrophy can be ruled out by seeing the other eye [60].

#### **10. Medical management**

Medical management is mostly supportive and not definitive [61]. Pressure bandages may be helpful in reducing the corneal edema; however, it increases the risk of bullous rupture with vascularized corneal scar. A study reported that the use of bandage contact lens decreases the corneal edema but increases the corneal hypoxia, which delays the process of corneal healing and causes dense scar [62]. Topical hypertonic saline (5%) eye drops are used to treat acute corneal edema to enhance dryness of the cornea, and these eye drops work by pulling the water out of the cornea thorough an osmotic pattern. Additionally, the risk of epithelial breakage is decreased, which in turn decreases the risk of secondary infection. However, the patients experience a severe burning sensation and discomfort after using the eye drop. Hence, the efficacy of these eye drops is questionable. Topical corticosteroid eye drops can be used to decrease the inflammation and improve the endothelial functioning. These may also decrease the corneal neovascularization and symptomatic ocular discomfort. However, the topical corticosteroid eye drop usage is associated with an increased risk of steroid-induced glaucoma, cataract, and infectious keratitis over the ruptured bullae. Hence, it should be used cautiously with close follow-ups [61].

### **11. Surgical management**

Various modalities of surgical management have been mentioned in literature to augment the process of corneal healing. All the methods mentioned in literature are equally efficient, providing a favorable visual outcome and preventing the formation of the corneal vascularization.

**7**

**Figure 4.**

**Figure 3.**

*Acute Hydrops and Its Management*

• Intracameral gas

*DOI: http://dx.doi.org/10.5772/intechopen.94592*

Surgical modalities are as follows:

• Compressive sutures (**Figures 3** and **4**)

• Deep anterior lamellar keratoplasty (DALK)

*Showing resolution of corneal edema after application of compressive sutures.*

*Complete resolution of corneal edema with clear visualization of anterior segment structures.*

Primary surgical intention for acute hydrops is not to restore or confer a normal vision but hasten the resolution of corneal edema which eventually leads to a non-

vascularised scar improving the prognosis for corneal transplantation.

• Combination of compressive sutures and intracameral gas (**Figure 5**)

• Mini Descemet membrane endothelial keratoplasty (mini-DMEK)

## *Acute Hydrops and Its Management DOI: http://dx.doi.org/10.5772/intechopen.94592*

Primary surgical intention for acute hydrops is not to restore or confer a normal vision but hasten the resolution of corneal edema which eventually leads to a nonvascularised scar improving the prognosis for corneal transplantation.

Surgical modalities are as follows:


*Eyesight and Imaging - Advances and New Perspectives*

detected.

uveitis [59].

by seeing the other eye [60].

**10. Medical management**

Calotropis keratitis commonly seen in the Indian subcontinent seen after accidental fall of whitish fluid while plucking the flower of the plant [55]. It may be localized or diffused and mostly presents as emergency having a perfectly normal vision before the fall. Upon slit lamp examination, a typical DM folds with the corneal edema are visible, and no breach in the continuity of DM is

Post-herpetic endothelial dysfunctions are seen typically after an episode of herpetic keratitis or most likely after herpes zoster ophthalmicus. Clinically, it is seen as the localized corneal edema with pigment dusting of the endothelium and

CMV keratitis is another rarely seen condition of the cornea that can be considered for the differential diagnosis of acute hydrops, and it typically manifests as a

Bullous keratopathy due to Fuchs endothelial corneal dystrophy can be ruled out

Medical management is mostly supportive and not definitive [61]. Pressure bandages may be helpful in reducing the corneal edema; however, it increases the risk of bullous rupture with vascularized corneal scar. A study reported that the use of bandage contact lens decreases the corneal edema but increases the corneal hypoxia, which delays the process of corneal healing and causes dense scar [62]. Topical hypertonic saline (5%) eye drops are used to treat acute corneal edema to enhance dryness of the cornea, and these eye drops work by pulling the water out of the cornea thorough an osmotic pattern. Additionally, the risk of epithelial breakage is decreased, which in turn decreases the risk of secondary infection. However, the patients experience a severe burning sensation and discomfort after using the eye drop. Hence, the efficacy of these eye drops is questionable. Topical corticosteroid eye drops can be used to decrease the inflammation and improve the endothelial functioning. These may also decrease the corneal neovascularization and symptomatic ocular discomfort. However, the topical corticosteroid eye drop usage is associated with an increased risk of steroid-induced glaucoma, cataract, and infectious keratitis over the ruptured bullae. Hence, it should be used cautiously with close

Various modalities of surgical management have been mentioned in literature to augment the process of corneal healing. All the methods mentioned in literature are equally efficient, providing a favorable visual outcome and preventing the forma-

Nuclear fragment retention after cataract surgery is a rare but a significant differential diagnosis, which manifests as on- and off-focal corneal edema mostly in the inferior quadrant. A careful clinical examination of an anterior segment reveals the presence of nuclear fragments and a positive history of recurrent anterior

the presence of sectoral iris atrophy in case of herpes zoster [56, 57].

focal corneal edema and appears as a coin-shaped lesion [58].

**6**

follow-ups [61].

**11. Surgical management**

tion of the corneal vascularization.


**Figure 4.** *Complete resolution of corneal edema with clear visualization of anterior segment structures.*

**Figure 5.** *Combination of compressive sutures with intracameral SF6 gas (Dr.Devi Aiswarya Das).*
