Bullous keratopathy describes an acute decompensation of corneal stromal tissue. Severe, acute, focal or generalized corneal edema may lead to the development of one or more large, unstable cornea bullae. Changes may develop extremely rapidly (typically within 24-48hrs), coalesce and/or rupture. Bullous keratopathy is diagnosed based on clinical findings. Treatment comprises the stabilization of the metalloprotease enzymes which mediate this process. In severe cases, or those associated with existing or impending corneal rupture, surgical resection of diseased tissue and/or tectonic corneal grafting procedures may be indicated.