Dr. Orwa Nasser MD MPH - Corneal Edema

Corneal Edema

Corneal edema is a condition in which excess fluid builds up within the cornea, causing it to swell and lose its normal clarity. Because the cornea must remain transparent to focus light properly, swelling can significantly affect vision and comfort. In a healthy eye, the endothelium actively pumps fluid out of the cornea. Corneal edema develops when this mechanism is damaged or overwhelmed.

Symptoms:

·    Blurred or cloudy vision.

·    Vision worse in the morning.

·    Halos or glare around lights.

·    Eye discomfort or pressure.

·    Foreign-body sensation.

·    Light sensitivity (photophobia).

·    Eye pain in advanced cases.

Causes:

·    Endothelial cell damage: Loss or dysfunction of endothelial cells reduces the cornea’s ability to remove excess fluid.

·    Fuchs’ dystrophy: Fuchs’ dystrophy is a common inherited cause of corneal edema due to gradual endothelial failure.

·    Eye surgery: Corneal edema may occur after Eye surgeries that stress or damage the endothelium.

·    Eye trauma: Blunt or penetrating injuries can impair endothelial pump function.

·    Elevated intraocular pressure: Increased eye pressure can interfere with endothelial fluid regulation.

·    Inflammation or infection: Severe or chronic inflammation may damage endothelial cells.

Diagnosis and Tests: Diagnosis includes slit-lamp examination, corneal thickness measurement (pachymetry), assessment of endothelial function, and measurement of intraocular pressure.

Management and Treatment:

·    Surgical treatment: Advanced corneal edema may require Cornea transplant, usually lamellar/partial thickness (DSEK or DMEK) 

·    Medications: Hypertonic saline eye drops or ointments may help draw fluid out of the cornea. Medications to lower intraocular pressure may also be used when appropriate.

·    Contact lens-based treatments: Scleral lenses may improve comfort and visual quality by creating a smooth optical surface over the cornea.

Prognosis: The prognosis depends on the underlying cause, the degree of endothelial damage, and how early treatment begins.

Prevention: Risk may be reduced through eye protection, regular eye examinations, management of eye pressure, and monitoring inherited corneal conditions.

When Should I See My Healthcare Provider? Seek medical evaluation for persistent blurred vision, increasing glare, or symptoms that do not improve.

When Should I Go to the Emergency Room? Urgent care is recommended for sudden vision loss, severe eye pain, or eye trauma.

What Questions Should I Ask My Healthcare Provider?

·    What is causing my corneal edema?

·    Is it temporary or progressive?

·    What treatments are available?

·    When should surgery be considered?

·    How will this affect my long-term vision?

Key Takeaways:

·    Corneal edema is caused by fluid buildup in the cornea.

·    The endothelium plays a critical role in preventing swelling.

·    Symptoms often include blurred vision and morning haze.

·    Treatment depends on severity and cause.

·    Advanced cases may require corneal surgery.