Acute Corneal Hydrops: A Comprehensive Review of Diagnosis, Treatment, and Outcomes

Purpose: This review provides an overview of acute corneal hydrops (ACHs), focusing on their risk factors, epidemiology, pathogenesis, imaging techniques, and treatment options. Methods: This narrative review was based on a literature search conducted in PubMed and Google Scholar, covering publications from 1980 to 2025. No restrictions were applied regarding language or study type. The identified studies were assessed for their relevance and clinical applicability to the diagnosis, management, and outcomes of ACHs. Results: ACHs are linked with corneal conditions like keratoconus (2.6%–7.5%), pellucid marginal degeneration (6%–11.5%), and keratoglobus (11%). It arises from structural changes in Bowman layer and the anterior stroma, triggered by factors such as trauma and increased intraocular pressure, leading to rupture of Descemet membrane. Risk factors include chronic allergic eye diseases (eg, vernal and atopic keratoconjunctivitis), eye rubbing, developmental conditions (eg, Down syndrome), early age, steeper keratometry, and reduced visual acuity at presentation. Imaging techniques such as ultrasound biomicroscopy, anterior segment optical coherence tomography, and in vivo confocal microscopy aid in characterizing CHs, monitoring recovery, and detecting complications. Treatments aim to reduce discomfort, promote healing, prevent complications, and support future visual rehabilitation. Conclusions: ACH develops in several corneal disorders, with risk factors overlapping those of keratoconus. Advances in imaging have improved the understanding of corneal changes, aiding in treatment and follow-up strategies. Despite various treatment options, no consensus exists on the best approach, underscoring the need for further studies to refine management and improve patient outcomes.