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.