Climatic droplet keratopathy in both eyes: A case report.

RATIONALE: Climatic droplet keratopathy is characterized by the formation of tiny, oil-like droplets on the cornea's surface, leading to discomfort and visual disturbances. This case report describes complex corneal opacity in the central pupillary zone, highlighting diagnostic challenges and the importance of early intervention.

PATIENT CONCERNS: The patient presented with persistent discomfort and progressive visual disturbances due to bilateral corneal opacity and epithelial changes.

DIAGNOSES: Initial clinical manifestations raised suspicion for corneal decompensation. Definitive exclusion of endothelial dystrophy was achieved through diagnostic surgical intervention (epithelial scraping in the right eye), which demonstrated intact endothelial function via rapid postoperative healing. The final diagnosis include bilateral climatic droplet keratopathy with cataracts.

INTERVENTIONS: Elective staged surgical excision was performed, beginning with epithelial scraping combined with cataract surgery in the right eye, followed by strategic excision of the Bowman layer and superficial stroma within a 5 mm × 5 mm pupillary zone in both eyes, demonstrating the value of selective intervention.

OUTCOMES: The surgical intervention achieved successful corneal re-epithelialization accompanied by significant visual acuity recovery. Serial follow-up over 12 months confirmed sustained restoration of central corneal transparency and stability in visual function.

LESSONS: This case establishes that diagnostic surgical scraping is essential to exclude endothelial dysfunction in climatic droplet keratopathy. Guided by this confirmation, targeted anterior lamellar keratectomy achieved successful visual rehabilitation, with sustained central corneal transparency objectively documented at 1-year follow-up.