Bullous Keratopathy

Bullous keratopathy is a condition in which the cornea becomes permanently swollen. This occurs because the inner layer of the cornea, the endothelium, has been damaged and is not pumping fluid properly (Figure 1). The cause of the endothelial damage could be from trauma, glaucoma, or inflammation after eye surgery.  Endothelial keratoplasty (EK) is the recommended treatment for bullous keratopathy.

Certain intraocular lens implant designs can damage the cornea. Sometimes it is helpful to replace a lens implant with a newer design when a transplant is being performed to prevent damage to the transplant.

The causes of bullous keratopathy have changed over the last two decades. Twenty years ago, the most common reason for bullous keratopathy was complications from cataract surgery with or without problems from intra-ocular lenses. Over the past 20 years, cataract surgery techniques and intra-ocular lens implants have improved dramatically. Now, corneal problems are less common after cataract surgery. Currently, one of the most common reasons for developing bullous keratopathy, or secondary corneal decompensation, is from problems related to glaucoma surgery.