Bullous keratopathy: Difference between revisions

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{{Refimprove|date=February 2017}}
{{Short description|A condition affecting the cornea of the eye}}
{{Infobox medical condition (new)
{{Use dmy dates|date=October 2023}}
| name            = Bullous keratopathy
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| image          = Cornea.png
| caption        = Bullous keratopathy is a condition that occurs in the cornea
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'''Bullous keratopathy''' is a pathological condition in which small vesicles, or ''[[Bulla (dermatology)|bullae]]'', are formed in the [[cornea]] due to [[corneal endothelium|endothelial]] dysfunction.


In a healthy cornea, endothelial cells keeps the tissue from excess fluid absorption, pumping it back into the aqueous humor. When affected by some reason, such as [[Fuchs' dystrophy]] or a trauma during cataract removal, endothelial cells suffer mortality or damage.<ref name="Stuart">{{cite journal |vauthors=Stuart AJ, Virgili G, Shortt AJ|title= Descemet's membrane endothelial keratoplasty versus Descemet's stripping automated  endothelial keratoplasty for corneal endothelial failure |journal=Cochrane Database Syst Rev|volume= |issue=3|pages= CD012097 |date=2016 |doi= 10.1002/14651858.CD012097}}</ref> The corneal endothelial cells normally do not undergo mitotic cell division, and cell loss results in permanent loss of function. When endothelial cell counts drop too low, the pump starts failing to function and fluid moves anterior into the stroma and epithelium. The excess fluid precipitates swelling of the cornea. As fluid accumulates between the basal epithelium cells, blister like formations form (bullae) and they undergo painful ruptures releasing their fluid content to the surface. These characteristic malformations disrupt vision and create pain sensations.
==Overview==
'''Bullous keratopathy''' is a pathological condition of the [[cornea]] characterized by the formation of fluid-filled blisters, or bullae, on the corneal surface. This condition often results from endothelial cell dysfunction, leading to corneal edema and subsequent visual impairment.
 
==Pathophysiology==
The cornea is composed of several layers, with the [[corneal endothelium]] playing a crucial role in maintaining corneal transparency by regulating fluid balance. In bullous keratopathy, damage to the endothelial cells disrupts this balance, causing fluid accumulation in the [[stroma]] and the formation of bullae on the [[epithelium]].
 
==Causes==
Bullous keratopathy can arise from various causes, including:
* [[Fuchs' dystrophy]]
* Surgical trauma, particularly following [[cataract surgery]]
* [[Glaucoma]]
* [[Corneal transplant]] rejection


==Symptoms==
==Symptoms==
Disease begins with vesicles that coalesce. There is severe progressing edema and rupture may occur in 24 hours or less.<ref>{{cite web|url=http://www.eyevet.ca/bullous.html|title=Eye Vet - Zigler Veterinary Professional Corporation|website=Eyevet.ca|accessdate=9 July 2018}}</ref>
Patients with bullous keratopathy may experience:
Bullous keratopathy
* Decreased visual acuity
* Pain and discomfort due to ruptured bullae
* Photophobia
* Foreign body sensation
 
==Diagnosis==
Diagnosis is primarily clinical, supported by slit-lamp examination revealing corneal edema and bullae. Additional tests such as [[specular microscopy]] can assess endothelial cell density.
 
==Treatment==
==Treatment==
 
Treatment options aim to relieve symptoms and restore corneal clarity. These include:
Treatment can include hyperosmotic eye drops to reduce swelling (5% sodium chloride), bandage contact lenses to reduce discomfort, glaucoma medications to reduce the flow of fluid into the cornea, and surgical procedures . The most common types of surgical treatment are Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet's membrane endothelial keratoplasty (DMEK).<ref name="Stuart"/>
* Hypertonic saline drops or ointments to reduce edema
* Bandage contact lenses for pain relief
* [[Corneal transplantation]] procedures, such as [[Descemet's stripping endothelial keratoplasty]] (DSEK) or [[Descemet's membrane endothelial keratoplasty]] (DMEK)


==Prognosis==
==Prognosis==
Keratopathy is common in older people. Keratopathy occurs after cataract surgery, its incidence has decreased since the advent of intraoperative viscoelastic agents that protect the endothelium.<ref>{{cite web|url=http://www.missionforvisionusa.org/anatomy/2005/11/bullous-keratopathy-of-cornea.html|title=Ocular Pathology: Bullous Keratopathy of the Cornea|website=Missionforvisionusa.org|accessdate=9 July 2018}}</ref>
The prognosis for bullous keratopathy varies depending on the underlying cause and the success of treatment interventions. Surgical options like endothelial keratoplasty have improved outcomes significantly.


==References==
==Prevention==
{{Reflist}}
Preventive measures focus on minimizing surgical trauma during ocular procedures and managing conditions like glaucoma effectively to reduce the risk of endothelial damage.
==External links==
{{Medical resources
|  DiseasesDB      = 32601 
|  ICD10          = H18.1 
|  ICD9            = {{ICD9|371.23}} 
|  ICDO            = 
|  OMIM            = 
|  MedlinePlus    = 
|  eMedicineSubj  = 
|  eMedicineTopic  = 
|  MeshID          =
}}


{{DEFAULTSORT:Bullous Keratopathy}}
==Related pages==
[[Category:Diseases of the eye and adnexa]]
* [[Corneal dystrophy]]
* [[Keratoconus]]
* [[Ophthalmology]]


[[File:Bullous_keratopathy_Cornea.png|thumb|right|Diagram of a cornea affected by bullous keratopathy]]


{{eye-disease-stub}}
[[Category:Eye diseases]]
{{dictionary-stub1}}
[[Category:Corneal disorders]]
{{No image}}

Revision as of 10:51, 15 February 2025

A condition affecting the cornea of the eye



Overview

Bullous keratopathy is a pathological condition of the cornea characterized by the formation of fluid-filled blisters, or bullae, on the corneal surface. This condition often results from endothelial cell dysfunction, leading to corneal edema and subsequent visual impairment.

Pathophysiology

The cornea is composed of several layers, with the corneal endothelium playing a crucial role in maintaining corneal transparency by regulating fluid balance. In bullous keratopathy, damage to the endothelial cells disrupts this balance, causing fluid accumulation in the stroma and the formation of bullae on the epithelium.

Causes

Bullous keratopathy can arise from various causes, including:

Symptoms

Patients with bullous keratopathy may experience:

  • Decreased visual acuity
  • Pain and discomfort due to ruptured bullae
  • Photophobia
  • Foreign body sensation

Diagnosis

Diagnosis is primarily clinical, supported by slit-lamp examination revealing corneal edema and bullae. Additional tests such as specular microscopy can assess endothelial cell density.

Treatment

Treatment options aim to relieve symptoms and restore corneal clarity. These include:

Prognosis

The prognosis for bullous keratopathy varies depending on the underlying cause and the success of treatment interventions. Surgical options like endothelial keratoplasty have improved outcomes significantly.

Prevention

Preventive measures focus on minimizing surgical trauma during ocular procedures and managing conditions like glaucoma effectively to reduce the risk of endothelial damage.

Related pages

File:Bullous keratopathy Cornea.png
Diagram of a cornea affected by bullous keratopathy
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