This guideline last updated 06/05/2022 17:54:15

Differential diagnosis

• Other causes of corneal oedema including Fuchs dystrophy and infective keratitis

Possible management by Optometrist

Treatment

• Cease contact lens wear
• Topical lubricants for symptomatic relief
• Consider prophylactic topical antibiotic if epithelial surface acutely disturbed by oedema and if secondary infection seems likely to occur
  • Ask if allergic to Chloramphenicol
  • If not, supply Chloramphenicol 1% eye ointment 3 times daily for 5 days
  • If allergic to Chloramphenicol, or pregnant, supply Fucidic acid 1% liquid gel twice a day for 5 days
• Cyclopentolate 1% 3 times daily until healed
• Consider padding eye to alleviate symptoms
• Avoid bandage contact lens (hypoxia may induce corneal vascularisation)
• Reassess corneal topography on resolution (often less steep after hydrops)

Advice

• Reassure patient that condition will resolve and may not ultimately affect visual function
• Review weekly for appearance of vascularisation or other complication
• Majority of cases resolve over 2-4 months
• May leave some stromal scarring

Management Category

• Normally no referral
• Urgent referral if vascularisation present

Possible management by Ophthalmologist

• As above
• Topical steroid
• Penetrating keratoplasty