ACUTE HYDROPS IN KERATOCONIC EYE – POST CORNEAL COLLAGEN CROSS LINKING :- A CLINICAL PARADOX

Background: Acute corneal hydrops is an uncommon but visually debilitating complication of keratoconus. It arises from a spontaneous break in Descemet's membrane, allowing aqueous humour to flood the corneal stroma, resulting in sudden corneal oedema, pain, and significant vision loss. Early identification and tailored treatment are essential to minimize complications and optimize visual outcomes. Case History: We report a case of a 16 year old male patient presented with acute hydrops in right eye with bilateral keratoconus. Patient had diminution of vision of both eyes for the past five years and had underwent collagen crosslinking procedure in both eyes 2 years back. Clinical examination showed decreased visual acuity, acute corneal hydrops , positive Munson's sign and Rizzutti phenomenon. Anterior segment OCT showed focal rupture of Descemet's membrane, associated stromal oedema & marked increase in local corneal thickness. Pachymetry showed advanced keratoconus with acute hydrops. Conclusion: Although most cases of acute hydrops resolve over time, appropriate conservative management can alleviate symptoms and support corneal recovery. Recent innovations such as intracameral gas injection have shown promise in accelerating resolution. For cases with persistent scarring, surgical options including keratoplasty may be necessary. Preventive strategies, particularly timely corneal cross-linking, are key to reducing the incidence of this complication in patients with progressive keratoconus.