What is Fuchs’ Corneal Dystrophy?
Fuchs’ dystrophy is a disease of the endothelial cells that line the inside of the cornea (clear portion in the front of the eye). These cells pump fluid out of the corneal tissue which keeps the cornea clear allowing for proper vision. In Fuchs’ dystrophy these cells begin to slowly deteriorate and die. This causes the cornea to swell and become cloudy which causes the symptoms related to Fuchs’ dystrophy. Fuchs’ dystrophy is diagnosed when an eye doctor sees guttata (small bump like lesions) forming in the endothelium. This is a clinical sign that the endothelial cells are failing. The condition was first described by Ernst Fuchs in Austria.
What Causes Fuchs’ Dystrophy?
In most cases Fuchs dystrophy is an autosomal dominant disease with high penetrance with other modifying factors. It appears to be slightly more prevalent in women.
Symptoms of Fuchs’ Dystrophy
Early signs of Fuchs’ dystrophy (guttata) may be seen in patients in their 30s to 40s. There are usually not any symptoms until people reach their 50s to 60s.
Blurred vision upon waking which slowly improves through the day
Problems with glare
Sensitivity to light (photophobia)
Blurred vision that does not clear through the day as the dystrophy worsens
A cloudy or hazy cornea
Painful eye as the cornea becomes more swollen forming blisters on its surface
Treatment of Fuchs’ Dystrophy
Medical Treatment of Fuchs’ Dystrophy
Medical treatment in the beginning may include hypertonic saline eye drops and the use of a hair dryer. The dryer should be held at arm’s length and set to warm. Two or three times a day blow warm air across the face to evaporate fluid off the cornea.
Surgical Treatment of Fuchs’ Dystrophy
Surgical treatment involves transplanting corneal donor tissue. This was previously done with a penetrating corneal transplant. This involved removing the central several millimeters of the cornea full thickness (all layers) and suturing in a new donor cornea. The recovery time for good vision could be 6 months to a year. A newer procedure is now being used called DSEK (Descemet’s Stripping Endothelial Keratoplasty) or DSAEK (Descemet’s Stripping Automated Endothelial Keratoplasty). These procedures involve only replacing the inside layers of the cornea. This allows for a much faster recovery time and a quicker return of vision.