Corneal edema develops as a consequence to a corneal endothelial or epithelial defect / abnormality. A chronic corneal ulcer will often have associated corneal edema, as the exposed corneal stroma imbibes fluid from the tear film. Alternatively, when there is damage to or dysfunction of the corneal endothelial cells (responsible for pumping fluid out of the cornea and maintaining a state of "deturgescence"), the cornea can become edematous. Corneal edema can also be seen in patients with inflammation associated with anterior uveitis, physical damage to the corneal endothelium (e.g. anteriorly luxated lens contacting the corneal endothelium), and degenerative or dystrophic changes in the corneal endothelial cells. One other rule out is glaucoma - with an increase in intraocular pressure, fluid (aqueous humor) can be driven into the corneal stroma and the endothelial cells simply can't pump it out efficiently.
In this case, we deduced that the corneal edema was secondary to corneal endothelial degeneration (this patient also had very early signs of corneal edema in his right eye). Initial treatment prescribed included a topical hyperosmotic (5% Sodium Chloride ophthalmic ointment) q 6-8 hrs, topical antibiotic ointment q 6 hrs (as there was a corneal erosion associated with a ruptured bullae), a cycloplegic agent (Atropine 1%) to manage the secondary ciliary spasm, and an E. collar. In some instances, therapeutic soft contact lenses may be suggested or surgical procedures recommended to manage or prevent recurrent bullae formation in a chronically edematous cornea.
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