A 37-year-old woman with painful unilateral vision loss.

INTRODUCTION

A 37‐year‐old woman presented to the emergency department with left eye pain and vision loss. She awoke with sudden onset vision loss the previous day, presented to her primary care physician, and was referred to ophthalmology for evaluation; however, her pain had acutely worsened. Physical examination revealed opacification of the left cornea (Figure 1). Visual acuity was hand motion in her left eye and 20/50 in the right eye.

FIGURE 1

Direct visualization of corneal opacification

DIAGNOSIS

Acute corneal hydrops. Physical examination revealed opacification of the cornea with significantly decreased vision. There was no fluorescein uptake (Figure 2). There was an outpouching of the cornea caused by fluid accumulation that could be appreciated on downward gaze; this is known as Munson's sign (Figure 3). This fluid accumulation is caused by a break in Descemet's membrane and the endothelium, which allows fluid to accumulate in the corneal stroma.

FIGURE 2

Fluorescein staining: no uptake

FIGURE 3

Munson's sign: superior view with a downward gaze demonstrating outpouching of the cornea due to accumulation of fluid within the corneal stroma

Acute corneal hydrops is a potential complication of keratoconus and other ectatic conditions. Ophthalmology evaluated the patient and diagnosed her with corneal hydrops in the setting of keratoconus. The patient had not been previously diagnosed with keratoconus. Medical management was recommended: sodium chloride 2% drops, prednisolone 1% drops, cyclopentolate 1% drops, and erythromycin ointment to the affected eye. Hypertonic saline is used to reduce edema, prednisolone is used for neovascularization prophylaxis, cyclopentolate is used for relief of pain, and erythromycin is used for infection prophylaxis. Medical management in corneal hydrops is not well studied. Corneal hydrops is often treated medically but may ultimately require corneal transplantation.