In vivo confocal microscopic and histological findings of unknown bullous keratopathy probably associated with pseudoexfoliation syndrome

BACKGROUND: Bullous keratopathy (BK), a severe sight-threatening disorder can have a variety of etiologies such as prophylactic laser iridotomy, intraocular surgery, trauma, and other ocular disorders. However, there are cases of unknown origins, among which a unique clinical entity namely pseudoexfoliation syndrome (PEX) is having increased importance. CASE PRESENTATION: In this case note, we report the clinical features and in vivo confocal microscopic and pathological findings of two BK cases of unknown cause. CONCLUSIONS: Our findings suggest that the BK was caused by the corneal endotheliopathy of PEX, a common disease that could affect up to 30% of people over 60 years old and is more prevalent than we have believed.