Development of Acute Hydrops in Eye with Infectious Keratitis: A case report

Abstract

Abstract Background: There have been relatively many reports of cases of acute hydrops followed by infectious keratitis, there has not been a report of cases of infectious keratitis complicated by acute hydrops. Case presentation: A 35-year-old man had undergone cataract surgery 7 years earlier and was being treated for atopic dermatitis by a neighborhood dermatologist. However, the dermatitis was poorly controlled. He came to our hospital with a complaint of pain and blurred vision in his left eye. The decimal best-correctly visual acuity (BCVA) of the left eye was 0.01. Slit-lamp microscopy showed conjunctival injection and a corneal opacity. The patient was diagnosed with infectious keratitis and treated with topical and systemic antibiotics. During his hospitalization, we noted that he frequently rubbed his eyes vigorously. Five days after the first visit, the cornea was noted to protrude markedly and the stroma surrounding an ulcerated area was edematous. These findings led to the diagnosis of acute hydrops and he underwent keratoplasty for the impending corneal perforation. Histopathological study of the excised cornea showed stromal edema, leucocyte infiltration, and a tear of Descemet membrane. Unfortunately, he developed endophthalmitis on the day after the surgery. We irrigated the anterior chamber with antibiotics and injected antibiotics into the vitreous. The endophthalmitis gradually subsided, and at two years after the surgery, his decimal BCVA had improved to 0.6. Conclusions: Eye rubbing in cases of infectious keratitis can induce acute hydrops and timely surgical intervention is recommended.