Infectious keratitis following topical steroid use in patients with acute corneal hydrops

ABSTRACT

To present two patients with acute corneal hydrops, superimposed with infectious keratitis using topical steroids. The first case was a 44-year-old man with acute corneal hydrops in his left eye which was on topical steroids for one week. Visual acuity was hand motion at presentation and there was a large epithelial defect with stromal infiltration and corneal edema on slit lamp examination. Corneal smear and culture were negative and the patient did not respond to aggressive antibiotic therapy. He underwent emergency tectonic corneal graft due to perforation and the eye was preserved. The second case was a 28-year-old woman, a known case of keratoconus with acute hydrops. She was using topical steroids and NaC1 5% for 4 days. Culture was positive for Gram-positive cocci. She underwent tectonic corneal graft, but endophthalmitis occurred which lead to phthisis. Acute corneal hydrops makes the eye more susceptible to superimposed infections. Topical steroids may aggravate this condition