Compromised endothelial cell pump mechanism as the endothelial cell density decreased and decompensated.
Can be secondary to congenital endothelial dystrophies, trauma, cataract or other surgical trauma, anterior chamber intraocular lens and prolonged inflammation.
Symptoms:
Mild to severe decreased vision
Painful from epithelial and subepithelial breakdown of the bulla
Tearing
Sensitivity to light
Decrease or loss of corneal sensation in advanced stage
Signs:
Epithelial and stromal edema
Microcysts and bulla formation
Subepithelial scarring from resolved chronic edema.
Management
Hyperosmotic sodium chloride 5% drops and ointment.
Soft contact lens to control the pain.
Intraocular pressure lowering medications.
Surgical: penetrating keratoplasty in advanced cases