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Bullous keratopathy
Medical expert of the article
Last reviewed: 04.07.2025
[ What causes bullous keratopathy?
Bullous keratopathy is caused by corneal edema due to the failure of the corneal endothelium to maintain normal water balance. It is most commonly associated with Fuchs' corneal endothelial dystrophy or corneal endothelial trauma. Corneal endothelial injury may occur during intraocular surgery (eg, cataract surgery) or after implantation of a poor-quality intraocular lens or malposition of the lens. Fuchs' dystrophy causes bilateral progressive loss of corneal endothelial cells, sometimes leading to bullous keratopathy in the 50s and 60s.
Symptoms of bullous keratopathy
Subepithelial fluid-filled blisters form bulges on the corneal surface and in the corneal stroma, causing discomfort, decreased visual acuity, loss of contrast, glare, and photophobia. Some blisters rupture, causing infection and ulceration of the cornea. The main symptom of rupture is moderate to severe pain.
Bullae and corneal stromal edema may be seen on slit lamp examination.
Treatment of bullous keratopathy
Treatment of bullous keratopathy should be performed by an ophthalmologist and includes the use of dehydrating agents (eg, hypertonic saline solutions), drugs that lower intraocular pressure, and soft contact lenses for mild to moderate symptoms. Corneal transplantation is usually successful.