Corneal hydrops in advanced keratoconus

We report a rare case of late unilateral corneal hydrops in a 45-year-old woman with advanced keratoconus and a history of failed penetrating keratoplasty in the contralateral eye. The patient, monocular and diabetic, presented with a five-year history of progressively declining vision in her left eye. Examination revealed severe corneal protrusion, diffuse stromal edema, Munson sign, corneal neovascularization, and a dense cataract. Anterior segment optical coherence tomography (AS-OCT) showed stromal thinning and fibrosis with a Descemet’s membrane tear with rolled edges, confirming chronic corneal hydrops. A penetrating keratoplasty was proposed. This case highlights the importance of early diagnosis, vigilant follow-up, and appropriate management of keratoconus to prevent severe complications such as corneal hydrops, which may ultimately require corneal transplantation, a non-conservative therapeutic option. Awareness of such rare late presentations is essential to optimize patient outcomes and preserve visual function.