Fuchs’ dystrophy is an inherited condition that affects the delicate inner layer (endothelium) of the cornea. This eye disease is slow progressing and usually affects both eyes. It occurs slightly more often in women than men. Generally the ophthalmologist can see early signs in people when they are in their thirties and forties, but it doesn't affect their eyesight until they reach their fifties and sixties.
The endothelium functions as a pump mechanism, constantly removing fluids from the cornea to maintain its clarity. The endothelial cells of people with Fuch's Dystrophy deteriorate for no apparent reason. As the disease progresses, the patient gradually loses these endothelial cells. Once lost, the endothelial cells do not grow back, but instead spread out to the fill empty spaces. The pumping system of the cornea becomes less efficient at pumping water from the stroma, causing corneal swelling. The normal curvature of the cornea changes. Eventually the epithelium absorbs water causing pain and visual impairment. A sight‐impairing haze may also appear in the tissue. Swelling produces tiny blisters on the surface of the cornea which may cause severe pain when the blisters burst.
Fuchs’ Dystrophy Symptoms
In the early stages, Fuchs’ patients notice glare and light sensitivity. As the dystrophy progresses, symptoms include hazy or blurred vision that is most pronounced in the morning and gradually clears during the day. This happens because the internal layers of the cornea tend to retain more moisture during sleep that evaporates in the tear film when a person is awake. Over time, the swelling will remain constant throughout the day and the person's vision will be reduced all day long. The patient may have a sandy or gritty sensation in the eyes.
Fuchs’ Dystrophy Treatment
Fuchs’ cannot be cured; however, with certain medications, blurred vision resulting from the corneal swelling can be controlled. Salt solutions such as sodium chloride drops or ointment are often prescribed to draw fluid from the cornea and reduce swelling. Another simple technique that reduces moisture in the cornea is to hold a hair dryer at arm’s length, blowing air into the face with the eyes closed. This technique draws moisture from the cornea, temporarily decreases swelling, and improves vision. If blisters occur, the patient can also use this technique two or three times a day to dry out the blisters. Using soft contact lenses or ointments can reduce corneal swelling. As the disease progresses, a corneal transplant may be required. Sometimes corneal transplant (also known as penetrating keratoplasty or PKP) is performed along with cataract and intraocular lens implant surgery. Short‐term results are generally good, but the Fuch's Dystrophy patient may experience a transplant failure after a long period of time.
Detection and Diagnosis of Fuchs’ Dystrophy
Fuchs’ is detected by examining the cornea with a slit lamp microscope that magnifies the endothelial cells thousands of times. The health of the endothelium is evaluated and monitored with pachymetry and specular microscopy.