Infectious Keratitis following acute corneal hydrops in Keratoconus patient: A rare case report

Purpose: To report a rare case of infectious keratitis complicating acute corneal hydrops (ACH) in a patient with Down syndrome and to discuss risk factors, clinical features, and management strategies.
Observation: A 20-year-old female with Down syndrome, atopic dermatitis, and a history of eye rubbing presented with acute corneal hydrops. Anterior segment OCT confirmed the rupture of Descemet’s membrane. Initial conservative treatment was initiated. Three days later, the patient presented with severe infectious keratitis. Corneal cultures grew Staphylococcus aureus, sensitive to topical tobramycin and ciprofloxacin. Gradual resolution of the infiltrate and the corneal edema was observed, leading to formation of a central corneal opacity after one month of treatment. 
Conclusion: Infectious keratitis is an uncommon but rapidly progressive complication of ACH. The reported risk factors included atopic dermatitis, eye rubbing, the use of topical corticosteroids and contact lens wear. Early detection through careful clinical assessment and imaging is critical to initiate antibiotic treatment. Despite infection control, visual prognosis remains poor due to residual corneal scarring and neovascularization. Prophylactic antibiotics may be considered in high-risk cases to prevent superinfection.