From the Guidelines
A cloudy cornea should be treated based on its underlying cause, with the primary goal of controlling the cause, improving visual acuity, and maximizing comfort, as outlined in the corneal edema and opacification preferred practice pattern 1. The condition can result from various factors including infections (bacterial, viral, or fungal keratitis), corneal edema (swelling), corneal dystrophies, trauma, or complications from contact lens wear.
- Treatment depends on the underlying cause:
- For infectious causes, antibiotic eye drops (such as moxifloxacin or tobramycin) for bacterial infections, antiviral medications (like acyclovir) for viral infections, or antifungal agents for fungal infections are prescribed.
- Corneal edema may be treated with hypertonic saline drops to draw out excess fluid.
- In cases of corneal dystrophies or severe scarring, a corneal transplant might be necessary. It's crucial to seek immediate medical attention from an ophthalmologist when experiencing corneal cloudiness, as delayed treatment can lead to permanent vision loss, as noted in the discussion of bacterial keratitis preferred practice pattern 1. The cornea normally remains transparent due to its unique cellular arrangement and lack of blood vessels, so any disruption to this structure affects its clarity and consequently, vision. Given the potential for serious complications, including loss of vision, prompt recognition and appropriate management of the underlying cause are essential, as emphasized in the guidelines for bacterial keratitis 1.
From the Research
Causes and Treatment of Cloudy Cornea
- Cloudy cornea, also known as corneal edema, is a common sign of acute or protracted corneal disease of various aetiologies 2.
- The pathophysiological bases and various causes of corneal edema are considered, and goals and techniques of medical and surgical therapies are reviewed 3.
Medical Treatment of Corneal Edema
- Corneal edema, if adequately understood and appropriately treated, generally shows a good prognosis 3, 2.
- Topical instillations of 5% hypertonic saline in a water soluble polymer solution can be used to treat corneal edema, with a majority of patients demonstrating improvement in visual acuity 4.
- The efficacy of hypertonic saline eye drops varies widely, depending on the specific corneal disorder being treated, with limited efficacy for bullous keratopathy and clinical improvement noted in most studies for corneal edema without epithelial involvement 5.
Use of Topical Ocular Hypertonic Saline
- Topical ocular hypertonic saline seems to be a safe and effective treatment in the management of less severe forms of corneal edema and other corneal disorders such as filamentary keratitis 5.
- A randomized crossover trial found that topical NaCl 6% eye ointment is more effective than NaCl 5% drops in the medical management of corneal edema, although NaCl 5% eye drops may be prescribed as an effective option for patients symptomatically intolerant to ointment 6.