Bullous Keratopathy

ByVatinee Y. Bunya, MD, MSCE, Scheie Eye Institute at the University of Pennsylvania
Reviewed/Revised Jul 2024
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Bullous keratopathy is an eye disorder that involves a blister-like swelling of the cornea (the clear layer in front of the iris and pupil).

  • Symptoms include sensitivity to bright light, blurred vision, and intermittent feeling of a foreign object in the eye.

  • Doctors diagnose bullous keratopathy based on the appearance of the person's cornea.

  • Treatment can include eye drops to draw the excess fluid from the cornea, medications to lower pressure in the eye, and corneal transplantation.

Bullous keratopathy is most common among older adults. It can occur by itself, may run in families, and, occasionally, occurs after eye surgery, such as cataract removal.

Symptoms of Bullous Keratopathy

The swelling leads to the formation of fluid-filled blisters on the surface of the cornea. Sensitivity when looking at bright lights and significant blurring of vision can result. The blisters can rupture, causing severe pain, often with the sensation of a foreign object trapped in the eye, and can further impair vision.

Symptoms are usually worse upon awakening because moisture accumulates when the eyes are closed. As the day wears on, the affected eye dries out as moisture evaporates, causing symptoms to resolve.

Bullous Keratopathy
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This photo shows blisters (arrows) on the surface of the cornea (bullous keratopathy).
© Springer Science+Business Media

Diagnosis of Bullous Keratopathy

  • A doctor's evaluation

The diagnosis of bullous keratopathy is based on the typical appearance of a swollen, cloudy cornea with blisters on the surface. A slit lamp

Treatment of Bullous Keratopathy

  • Salty eye drops

  • Medications to lower pressure in the eye

  • Sometimes soft contact lenses

  • Sometimes corneal transplantation

Bullous keratopathy is treated by an ophthalmologist (a medical doctor who specializes in the evaluation and treatment—surgical and nonsurgical—of eye disorders).

Medications that lower the pressure in the eye are sometimes given.

On occasion, soft contact lenses can be used for a short period of time to decrease discomfort by acting as a bandage to the cornea.

If vision is reduced or discomfort is significant and prolonged, corneal transplantation is often done.

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