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The authors present an up-to-date review of stromal hydration of the cornea and its controlling mechanisms. Stromal hydration quantifies the water component of the stroma. Its regularization depends on different factors which were detailed as; swelling pressure, corneal endothelial and epithelial metabolic pumps and barriers, tear film evaporation and intraocular pressure. Finally, the authors present different clinical procedures for evaluating stromal hydration, such as, the fluorophotometry and hypoxic-stress. This study shows the importance of stromal physiology and the consequences of all surgical or pathological modifications.

Keratocytes are differentiated mesenchymal fibroblast which are specialized in the production and maintenance of the transparent corneal stroma. These elongated cells with large nuclei and scant cytoplasm produce the collages, proteoglycans, and glycoproteins which make up the stroma, as well as the enzymes involved in post-translation modifications and catabolism of these macromolecules. The characteristic morphological features and specific metabolic activity of keratocytes undergo significant changes during tissue repair and in several corneal diseases. Alterations in keratocyte biosynthetic activity, regardless of their cause, ultimately lead to fibrillar alterations responsible for a loss of corneal transparency.