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Eruptive Bullous Keratophathy

 

Corneal Hydrops

Feline Eruptive Bullous Keratopathy was first described by Nasisse. It is a condition characterized by severe rapidly progressing corneal edema. The disease begins with focal vesicles that rapidly coalesce into bullae. The peripheral cornea is generally affected first. Rupture of the bullae and corneal perforation may occur in 24 hours or less. Some veterinary ophthalmologists prefer to use the term Corneal Hydrops.

Eruptive Bullous Keratopathy is not associated with injury or concurrent disease. Affected cats tend to be young, and the Persian and Himalayan are over represented.

Many questions remain as the nature of this disease:

  • Is it immune mediated?
  • What is the role of herpesvirus infection?
  • Is this a stromal disease or an endothelial disease?

Current opinion would suggest that this is a stromal disease since the amount of edema which results far exceeds that which is observed in cases where there is naturally occurring injury to either the corneal epithelium or the corneal endothelium.

Since little is known about this unusual condition, it is prudent to collect as much information as possible from affected cats. The recommended diagnostic work-up includes a routine CBC, chemistry profile and urinalysis, FeLV, FIV, FIP & Toxo, corneal scrapings for Cytology & Gram's Stain, Herpesvirus PCR test & Chlamydia immunoflurescence or eliza test and possibly culture and sensitivity test if bacteria are noted on the cytology.

Treatment of Eruptive Bullous Keratopathy is the application of a conjunctival graft preferably leaving axial cornea exposed, followed with the use of topical antibiotic, atropine, 5% NaCl ointment. In an emergency situation, the veterinarian may apply 50% dextrose solution to the cornea in an effort to dehydrate the tissue while referral is arranged.

Eruptive Bullous Keratopathy tends to resolve with little to no stromal scarring or progress rapidly to corneal perforation. The disease may be bilateral and may be recurrent.