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| ARTICLES |
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| Year : 1985 | Volume
: 33
| Issue : 2 | Page : 121-123 |
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Acute hydrops in keratoglobus with vernal keratoconjunctivitis
VP Gupta, RK Jain, SK Angra
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
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 3833736 
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 2021 Jun 21];33:121-3. Available from: https://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 | |  |
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 | | |
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 | | |
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 | | |
| 1. | Cavara, V. 1950, Brit. J. Ophthalmol. 34 : 621.  |
| 2. | Rrayson, M., 1963, Amer. J. Ophthalmol. 56 300. |
| 3. | Duane, T.D., 1981, Clinical ophthalmology 16: 6. |
| 4. | Duke Elder, S., 1964, System of Ophthalmology. Vol. 3 normal and abnormal development. Part 2. Congenital deformities, London, Henry Kimpton, pp. 508. |
| 5. | Jacobs, D.S, Green W.R. and Maumance D 1974: Amer. J. Ophthalmol. 77:393. |
| 6. | Theodore, F.K. and Seblossman, A., 1958, Ocular allergy. p 108. |
| 7. | Hara, T, 1970, Exp, Eye Res. 10 : 302. |
| 8. | Fraunfelder, F.T., 1976, Drug Induced ocular side effects and drug interactions philadelphia, Lea & Febiger, pp 182. |
| 9. | Angra. S.K., 1982, Ind. J Ophthalmol. 30;213. |
[Figure - 1], [Figure - 2], [Figure - 3]
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