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What Is a Khodadoust Line?

A Khodadoust line is a visible line of inflammatory cells on the inner corneal surface that signals endothelial graft rejection. It is seen after corneal transplantation, including full-thickness and some endothelial keratoplasty procedures. The line often marks a boundary between damaged endothelium and healthier endothelium and can move across the cornea over time. Because endothelial rejection can quickly lead to corneal swelling and vision loss, it requires urgent ophthalmic care.

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What Is a Khodadoust Line?

A Khodadoust line is a visible line of inflammatory cells on the inner corneal surface that signals endothelial graft rejection. It is seen after corneal transplantation, including full-thickness and some endothelial keratoplasty procedures. The line often marks a boundary between damaged endothelium and healthier endothelium and can move across the cornea over time. Because endothelial rejection can quickly lead to corneal swelling and vision loss, it requires urgent ophthalmic care.

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What Causes a Khodadoust Line?

A Khodadoust line forms when the immune system attacks donor endothelial cells after a corneal transplant. Inflammatory cells accumulate on the endothelium and create a migrating rejection line, often starting near the graft edge. Risk can be higher in eyes with prior rejection episodes, significant inflammation, or corneal vascularization.

Rejection is not the same as infection, but both can cause a red, painful eye and need prompt evaluation.

How Is It Diagnosed?

An eye doctor diagnoses a Khodadoust line during a slit-lamp examination. The clinician typically looks for associated findings such as corneal edema, keratic precipitates, anterior chamber cells, and reduced vision. Because early treatment can be vision-saving, diagnosis is based on clinical signs and should not be delayed while waiting for tests.

Your clinician may also assess eye pressure and review transplant history to guide urgency and treatment intensity.

How Is It Treated?

Treatment is aimed at stopping immune damage to the endothelium as quickly as possible. High-dose topical corticosteroids are commonly used, and dosing may be very frequent early in treatment. In more severe cases or in high-risk eyes, a clinician may add systemic steroids or adjust other immunosuppressive therapy when appropriate.

Follow-up is usually close, because response within days can determine whether the graft can recover.

When Is It an Emergency?

A suspected Khodadoust line should be treated as urgent, especially if vision is worsening. Seek same-day evaluation for redness, light sensitivity, pain, or new corneal haze after any corneal transplant. Emergency care is recommended if there is a sudden major vision drop, severe pain, or significant discharge, because infection or severe rejection can threaten the eye.

Do not self-treat with leftover drops unless a clinician directs you, because incorrect treatment can worsen infection or delay care.

FAQs on Khodadoust Lines

Can a Khodadoust line happen years after a transplant?

Yes. Graft rejection can occur months or years after transplantation, especially if steroid prophylaxis is reduced, inflammation increases, or new risk factors develop.

Is a Khodadoust line always visible to the patient?

Usually not. Many people only notice symptoms such as blurred vision, redness, or light sensitivity, while the line itself is seen by a clinician on exam.

Can endothelial rejection be reversed?

It can be, especially when treated early and aggressively. Delayed treatment increases the chance of permanent endothelial failure and the need for repeat transplantation.

What symptoms should prompt immediate care after a corneal transplant?

Seek immediate care for symptoms sometimes summarized as sudden redness, sensitivity to light, vision change, or pain.

  • New blur or haze
  • Increasing redness or discomfort
  • Light sensitivity or worsening tearing

Early evaluation helps distinguish rejection from infection and protects graft survival.

References

Corneal Allograft Rejection and Failure. EyeWiki. https://eyewiki.org/Corneal_Allograft_Rejection_and_Failure. May 14, 2025.

Atlas Entry: Khodadoust Line (Corneal Endothelial Rejection). EyeRounds, University of Iowa Health Care. https://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/khodadoust-line.htm. 2016.

Corneal Graft Rejection. StatPearls via National Center for Biotechnology Information Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK519043/. June 11, 2023.

Penetrating Keratoplasty. EyeWiki. https://eyewiki.org/Penetrating_Keratoplasty. June 29, 2025.

Immunopathology of Corneal Allograft Rejection and Failure. PubMed Central, National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC11430735/. 2024.