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ARTICLES
Year : 1985  |  Volume : 33  |  Issue : 2  |  Page : 121-123

Acute hydrops in keratoglobus with vernal keratoconjunctivitis


Dr Rajendra Prasad Centre for Ophthalmic Sciences A.I.I.M.S., New Delhi, India

Correspondence Address:
V P Gupta
Deptt. of Ophthalmology Medical College Rohtak (Haryana)
India
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Source of Support: None, Conflict of Interest: None


PMID: 3833736

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How to cite this article:
Gupta V P, Jain R K, Angra S K. Acute hydrops in keratoglobus with vernal keratoconjunctivitis. Indian J Ophthalmol 1985;33:121-3

How to cite this URL:
Gupta V P, Jain R K, Angra S K. Acute hydrops in keratoglobus with vernal keratoconjunctivitis. Indian J Ophthalmol [serial online] 1985 [cited 2019 Dec 7];33:121-3. Available from: http://www.ijo.in/text.asp?1985/33/2/121/30836

Acute hydrops in keratoglobus is an extre­mely rare condition[1],[2]. Keratoglobus secon­dary to vernal catarrh is not reported. More­over, acute hydrops in secondary keratoglobus due to vernal catarrh is further not docu­mented. We are describing a case of acute hydrops in keratoglobus in a patient with vernal keratoconjunctivitis.


  Case report Top


A 15 year old boy presented with the his­tory of recurrent attacks of itching, redness, watering, photophobia and gradual diminu­tion in vision in both eyes for three years with symptoms in the left eye more severe as com­pared to the right eye. He had been treated with frequent instillations of corticosteroid drops, the frequency and duration of use was more in the left eye.

Three months back his symptoms in the left eye suddenly worsened with marked dete­rioration in vision, and appearance of whitish opacity in the black of left eye. There was no positive history of trauma. There were no ocular complaints prior to these episodes and he never used any glasses. Family history was unremarkable. General physical and sys­temic examination did not reveal any abnor­mality. Ocular examination revealed a visual acuity of 6/12 p with+2.0 Dsph. -8.0 D.cyl. axis 60° in the right eye and count finger at one meter in left eye. The upper palpebral conjunctiva showed a cobblestone appear­ance where as the pericorneal conjunctiva was thickened and injected in both eyes. The gelatinous limbal excrescences were seen bila­terally [Figure - 1]. The anterior segment and fundus of right eye were normal. However, the left cornea was globular in shape with superficial vascularization and peripheral cor­neal-thinning. The central cornea was edema­tous with breaks in the Descemet's membrane [Figure - 2]. Remaining anterior segment struc­tures were normal. Fundus in the left eye could not be visualized due to corneal clou­diness. Intraocular pressure in the right eye was 14.0 mm Hg (applanation) and in the left eye it was felt to be normal digitally.

Pachometry (Haagstreit attachment I & II) revealed a corneal thickness of 0.66 mm in the centre and 0.78 mm at the periphery in the right eye while it was 1.10 mm in the centre and 0.56 mm at the periphery of left eye. Anterior chamber depth was 3.8 mm in right eye and 4.00 mm in the left eye. Ver­tical corneal diameter (mm) were 11.5 and 12.0 in the right and left eye respectively where as horizontal diameter were 12 and 13mm in respectively.

Keratometry reading in the right eye was 41.7/47.2 axis 150 and distorted mires were observed in the left eye. Gonioscopy of the right eye revealed no abnormality.

Conjunctival cytology demonstrated eosi­nophils. Conjunctival swabs were sterile.

He was diagnosed as bilateral vernal keratoconjunctivitis and secondary keratoglo­bus with acute hydrops in the left eye. He was treated with diluted (1 : 10) Dexametha­sone drops, both eyes eight times per day. In the left eye glycerol 10% drops and soframy­cin eye drops qid and pressure patching was done at night. Systemically patient was given tab. Diamox 1 tid and syrup glycerol 1 oz. tid. The response to above therapy was excellent. The corneal edema decreased gra­dually and disappeared in three months [Figure - 3] The corneal thickness in the left eye returned to 0.70 mm in the Center and 0.56 mm in the periphery. The corneal opacity was thinned down but the globular shape was persistent. His symptoms also disappeared and visual acuity in the left eye improved to 6/36 with -4.25 D. sph.


  Discussion Top


Keratoglobus is a rare anomaly of the cor­nea characterized by globular protrusion of the cornea with thinning at the periphery[3],[4] Keratoglobus could be divided into congeni­tal (Primary) and acquired (secondary) forms. Primary keratoglobus is la rare bilateral cong­enital disorder, the nature of which has been disputed. Secondary keratoglobus could occur in a case of keratoconus[2]. Jacobs et al 1974 have described acquired keratoglobus in a patient with hyperthyroidism[5]. The occurre­nce of keratoglobus secondary to vernal catarrh has been mentioned[6] however, no report is available in the literature.

There were various features which were suggestive of secondary nature of keratoglo­bus in this patient. Firstly the patient did not have any ocular pathology before he suffered from vernal catarrh. Secondly kera­toglobus was present only in left eye. Furthermore the vernal catarrh in the left eye was more severe, therefore, the frequency and duration of usage of steroid drops wlo ere as more in the left eye.

The aetiopathogenetic factors of secon­dary keratoglobus in this patient could be vernal catarrh, topical steroids and genetic predisposition. Either one of these factors might have resulted in secondary keratoglo­bus or there could be a combined effect i.e. all these factors contributing simultaneously. Limbal vernal catarrh could lead to kerato­globus by various mechanisms viz. nutritional. (timbal ischaemia), dystrophic effect, toxin liberated at the limbus and constant rubbings.

Corneal thinning following topical appli­cation of corticosteroids has been reported by various investigators[7],[8]. The duration and frequency of steroid drops in the left eye was more in this case which might have resulted in corneal thinning only in one eye. As regards the genetic predisposition, the association of keratoconus in atopic diseases is well established and since the familial association between keratoconus and kerato­globus have been described[1], therefore, the association of keratoglobus in vernal catarrh could also be considered. Finally we feel that aetiopathogenesis of secondary kerato­globus in this patient seems to be multifactorial wherein the vernal catarrh, long term use of topical steroids and genetic predispo­sition, all combined have led to this con­dition. The medical therapy instituted helped the amelioration from basic disease by diluted corticosteroids and the latter also helped in the stabilization of corneal struc­ture. The steroids have bimodal action and the diluted steroids have beneficial effect[9]. The deturgescent drops and lowering of intra­ocular pressure are supportive therapy. Medi­cal therapy has no role in the reversal of keratoglobus changes which are permanent.


  Summary Top


Acute hydrops in keratoglobus with ver­nal catarrh is not documented in literature. We report a case of acute hydrops in keratoglobus with vernal keratoconjuncti­vitis. The aetiopathogenesis of keratoglobus in this patient has been discussed.

 
  References Top

1.
Cavara, V. 1950, Brit. J. Ophthalmol. 34 : 621.  Back to cited text no. 1
    
2.
Rrayson, M., 1963, Amer. J. Ophthalmol. 56 300.  Back to cited text no. 2
    
3.
Duane, T.D., 1981, Clinical ophthalmology 16: 6.  Back to cited text no. 3
    
4.
Duke Elder, S., 1964, System of Ophthalmology. Vol. 3 normal and abnormal development. Part 2. Congenital deformities, London, Henry Kimpton, pp. 508.  Back to cited text no. 4
    
5.
Jacobs, D.S, Green W.R. and Maumance D 1974: Amer. J. Ophthalmol. 77:393.  Back to cited text no. 5
    
6.
Theodore, F.K. and Seblossman, A., 1958, Ocular allergy. p 108.  Back to cited text no. 6
    
7.
Hara, T, 1970, Exp, Eye Res. 10 : 302.  Back to cited text no. 7
    
8.
Fraunfelder, F.T., 1976, Drug Induced ocular side effects and drug interactions philadelphia, Lea & Febiger, pp 182.  Back to cited text no. 8
    
9.
Angra. S.K., 1982, Ind. J Ophthalmol. 30;213.  Back to cited text no. 9
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]


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