A patient on long-term topical steroids for keratoconus develops an acute hydrops episode. The mechanism is:
- A Steroid-induced IOP rise causing Descemet's membrane rupture
- B Spontaneous rupture of Descemet's membrane allowing aqueous ingress into stroma ✓
- C Vascularisation causing subepithelial bulla formation
- D Inflammatory cytokine-mediated stromal oedema
Explanation
Acute hydrops in keratoconus results from spontaneous rupture of the thinned and stretched Descemet's membrane at the cone apex, allowing aqueous humour to flood into the corneal stroma, causing sudden stromal oedema. The patient experiences acute decrease in vision with pain and photophobia. Descemet's membrane breaks are seen as folded, scrolled edges on slit-lamp and OCT. Management is conservative (hypertonic saline, cycloplegia, IOP control), with resolution in 2–3 months producing a scar that may paradoxically improve the conical shape. Intracameral C3F8 gas injection accelerates closure of the break.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.