Empower Relief: Understanding Bullous Keratopathy & Effective Treatments

What is bullous keratopathy?

Bullous keratopathy is a painful condition of the cornea. It is caused due to the decompensation of the endothelial layer of the cornea and leading to edema. The decompensation leads to cysts formation on the surface epithelium of the cornea. The rupture of the cyst leads to a painful state.

Empower Relief: Understanding Bullous Keratopathy & Effective Treatments
This photo shows blisters (arrows) on the surface of the cornea (bullous keratopathy).

Pseudophakic bullous keratopathy

In pseudophakic bullous keratopathy, the keratopathy develops after the artificial intraocular lens implantation. Various mechanisms can be involved

  • Diabetic patient with low endothelial count
  • Aggressive surgical manipulation and loss of endothelial cells
  • Vitreous in the anterior chamber and giving trauma to endothelial cells
Empower Relief: Understanding Bullous Keratopathy & Effective Treatments

Aphakic bullous keratopathy

In aphakic the mechanism of bullous keratopathy is same as that of pseudophakic patients however the chances of vitreous in the anterior chamber to enter are more.

Bullous keratopathy causes

What are the causes of bullous keratopathy?

The main cause of bullous keratopathy is due to the loss of normally occurring endothelial cells on the inner most layer of the corneal. These are naturally occurring cells ranging from 6000 to 7000 per mm3. Every year there is 0.6% loss of these endothelial cells in normal individuals, however in diabetic this count is much less and they are more prone to the bullous keratopathy. Any condition reducing the count of endothelial cells to 600 per mm3 is responsible for causing corneal edema and subsequently bullous keratopathy.

Bullous keratopathy symptoms

What are the symptoms of bullous keratopathy?

These includes

  • Blurring of vision
  • Photophobia
  • Pain
  • Watering and redness
  • Foreign body sensation

Bullous keratopathy treatment

What are the treatment options of bullous keratopathy?

The general treatment of bullous keratopathy includes

Medical treatment

  • Topical lubricant
  • Topical pressure lowering drugs
  • Topical 5 % hypertonic saline solution
  • Topical cycloplegics
  • Application bandage contact lens

Surgical management

If visual acuity is good then the following surgical options are used

  • Penetrating keratoplasty
  • Descemet stripping endothelial keratoplasty
  • Pars Plana vitrectomy
  • Triple procedure

If visual acuity is not good then following procedures are used

  • Tarsorrhaphy
  • Botox injection to eyelid
  • Conjunctival flap
  • Amniotic membrane transplant

What eye drops for bullous keratopathy?

Hypertonic saline solutions, such as 5% sodium chloride solution, are commonly used as eye drops to temporarily manage corneal edema in bullous keratopathy.

What are the clinical features of bullous keratopathy?

Clinically, bullous keratopathy is characterized by the presence of multiple fluid-filled bullae on the corneal surface, typically affecting the lower part of the cornea. Slit-lamp examination, a specialized eye examination, can further confirm the diagnosis.


Bullous keratopathy is a painful condition. It is important to perform pre operative evaluation of the patient and his endothelial count. During the surgery lesser manipulation should be done to avoid endothelial damage. In case of any complication, it is necessary to handle the situation well on time in order to avoid permanent loss of endothelial cells.


Which layer is involved in bullous keratopathy?

Mainly, the endothelial layer is involved leading to stromal involvement and then epithelial bullae are formed.

What is another name for bullous keratopathy?

Other name for less severe form of bullous keratopathy is striate keratopathy.

What is the difference between keratitis and keratopathy?

Keratitis is an infectious condition caused due to microorganisms. However, keratopathy is a sterile condition, not related to organisms.

Is bullous keratopathy painful?

When the epithelium of cornea is involved, tiny cysts are formed which coalesce and finally ruptures. The rupturing of bullae causes painful condition.

Does keratopathy affect vision?

Yes, visual equity is affected with bullous keratopathy. In the long run, the management of bullous keratopathy depends upon the final visual outcome.

Can bullous keratopathy be cured?

Yes, bullous keratopathy can be cured with topical eye drops or certain surgical procedures.

What is the best treatment for corneal edema?

The best treatment for corneal edema is 5% topical hypertonic saline. It reduces the water content of cornea and hence reduce edema.

What eye drops are for bullous keratopathy?

Various eye drops are used in combination for bullous keratopathy such as topical lubricants, cycloplegics, 5% hypertonic saline and pressure lowering drugs.

Dr Sadia Ayaz
Dr Sadia Ayaz

I am an ophthalmologist and eye surgeon

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