To manage hydrops in keratoconus, which combination is used?

• A. NaCl 5% qid and Cyclopentolate 1% tid for 1–2 weeks
• B. Oral acetazolamide
• C. Topical steroids alone
• D. Continue regular glasses without treatment

Answer: (A)

In hydrops from keratoconus, the corneal edema needs to be reduced quickly while keeping the eye comfortable. The most effective approach is to use hypertonic saline to draw fluid out of the swollen cornea and a cycloplegic to relieve pain from ciliary spasm. A 5% sodium chloride solution given four times daily helps move excess fluid from the stroma back toward the tear film, helping the edema decrease. Pairing this with a cycloplegic such as cyclopentolate 1% three times daily minimizes pain, photophobia, and accommodation spasm as the cornea heals. This combination is typically continued for about 1–2 weeks or until the edema resolves. Other options don’t address the edema adequately (oral acetazolamide isn’t standard for hydrops), steroids alone don’t resolve the swelling and may hinder healing, and doing nothing with glasses misses the chance to relieve the edema and discomfort.