Summary about Disease
Bullous keratopathy is a degenerative corneal condition characterized by the formation of fluid-filled blisters (bullae) on the cornea, leading to corneal swelling, pain, and blurred vision. It occurs when the endothelial cells, which pump fluid out of the cornea to keep it clear, become damaged or dysfunctional. This causes fluid to accumulate within the corneal layers, causing it to thicken and become opaque.
Symptoms
Blurred vision (often worse in the morning)
Glare or halos around lights
Eye pain or discomfort
Foreign body sensation
Tearing
Light sensitivity (photophobia)
Reduced vision
Small, painful blisters on the cornea
Causes
Pseudophakic Bullous Keratopathy (PBK): The most common cause, occurring after cataract surgery with intraocular lens (IOL) implantation. It develops due to damage to the corneal endothelium during surgery.
Aphakic Bullous Keratopathy: Occurs after cataract surgery without an IOL.
Fuchs' Endothelial Dystrophy: A genetic condition where the corneal endothelial cells gradually degenerate, leading to bullous keratopathy.
Trauma: Injury to the cornea can damage the endothelium.
Inflammation: Conditions like uveitis can damage the endothelium.
Congenital: Rare cases can be present at birth due to endothelial abnormalities.
Glaucoma: Advanced glaucoma can, in some cases, contribute to endothelial cell damage.
Medicine Used
Hypertonic Saline Eye Drops (e.g., Muro 128): These draw fluid out of the cornea to reduce swelling.
Lubricating Eye Drops and Ointments: Provide comfort and protect the cornea.
Bandage Contact Lenses: Can act as a protective barrier and reduce pain.
Topical Corticosteroids: Used to reduce inflammation in some cases, but with caution due to potential side effects.
Pain relievers: Over-the-counter or prescription pain medication may be needed to manage pain.
Is Communicable
No, bullous keratopathy is not a communicable or contagious disease. It is not caused by an infection that can be spread from person to person.
Precautions
Protect your eyes: Wear protective eyewear during activities that could cause eye injury.
Follow doctor's instructions: Adhere to prescribed medications and follow-up appointments.
Maintain good hygiene: Wash hands thoroughly before touching your eyes.
Avoid rubbing your eyes: This can further damage the cornea.
Control underlying conditions: Manage conditions like diabetes or glaucoma, which can worsen corneal health.
Use lubricating eye drops regularly: To keep the cornea moist and prevent dryness.
How long does an outbreak last?
Bullous keratopathy is a chronic condition, not an "outbreak." Symptoms can persist indefinitely if left untreated. The duration of symptoms varies depending on the severity of the condition and the effectiveness of treatment. Without intervention, the condition progressively worsens.
How is it diagnosed?
Slit-lamp Examination: A detailed examination of the cornea using a microscope.
Pachymetry: Measures the thickness of the cornea.
Specular Microscopy: Counts and assesses the health of the endothelial cells.
Patient History: A review of the patient's medical history, including previous eye surgeries and underlying conditions.
Visual Acuity Test: Measures the patient's vision.
Timeline of Symptoms
The timeline of symptoms can vary, but a general progression is:
Early Stages: Mild blurring of vision, especially in the morning.
Intermediate Stages: Increased blurring, glare or halos around lights, occasional eye pain.
Advanced Stages: Significant vision loss, constant pain, frequent tearing, and foreign body sensation. The development of visible bullae on the cornea.
Important Considerations
Early Diagnosis: Early diagnosis and treatment are crucial to slow the progression of the disease and prevent further vision loss.
Surgical Options: Corneal transplantation (e.g., Descemet's Stripping Automated Endothelial Keratoplasty - DSAEK or Descemet's Membrane Endothelial Keratoplasty - DMEK) may be necessary in severe cases to restore vision.
Potential for Vision Loss: Untreated bullous keratopathy can lead to significant and permanent vision loss.
Underlying Cause: Identifying and addressing the underlying cause of bullous keratopathy is essential for effective management.
Regular Follow-up: Patients with bullous keratopathy require regular eye exams to monitor the condition and adjust treatment as needed.