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Bullous Keratopathy

By

Melvin I. Roat

, MD, FACS, Sidney Kimmel Medical College at Thomas Jefferson University

Last full review/revision May 2020| Content last modified May 2020

Bullous keratopathy is an eye disorder that involves a blister-like swelling of the cornea (the clear layer in front of the iris and pupil).

  • Symptoms include sensitivity to bright light, blurred vision, and intermittent feeling of a foreign object in the eye.
  • Doctors diagnose bullous keratopathy based on the appearance of the person's cornea.
  • Treatment can include eye drops to draw the excess fluid from the cornea, drugs to lower pressure in the eye, and corneal transplantation.

(See also Introduction to Corneal Disorders.)

An Inside Look at the Eye

An Inside Look at the Eye

Bullous keratopathy is most common among older people. It can occur by itself, may run in families, and, occasionally, occurs after eye surgery, such as cataract removal.

Symptoms of Bullous Keratopathy

The swelling leads to the formation of fluid-filled blisters on the surface of the cornea. Sensitivity when looking at bright lights and significant blurring of vision can result. The blisters can rupture, causing severe pain, often with the sensation of a foreign object trapped in the eye, and can further impair vision.

Diagnosis of Bullous Keratopathy

  • A doctor's evaluation

The diagnosis of bullous keratopathy is based on the typical appearance of a swollen, cloudy cornea with blisters on the surface. A slit lamp, an instrument that enables a doctor to examine the eye under high magnification, is used to examine the cornea. During the examination, the doctor may apply eye drops that contain a yellow-green dye called fluorescein. The fluorescein temporarily stains damaged areas of the cornea, making it possible to see damaged areas that are not otherwise visible.

Treatment of Bullous Keratopathy

  • Salty eye drops
  • Drugs to lower pressure in the eye
  • Sometimes soft contact lenses
  • Sometimes corneal transplantation

Bullous keratopathy is treated by an ophthalmologist (a medical doctor who specializes in the evaluation and treatment—surgical and nonsurgical—of eye disorders).

Salty eye drops (hypertonic saline) and salty ointments (hypertonic sodium chloride) are used to draw the excess fluid from the cornea.

Drugs that lower the pressure in the eye are sometimes given.

On occasion, soft contact lenses can be used for a short period of time to decrease discomfort by acting as a bandage to the cornea.

If vision is reduced or discomfort is significant and prolonged, corneal transplantation is often done.

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