Fuchs' Endothelial Dystrophy
Fuchs’ dystrophy is a slowly progressive, degenerative disease of the cornea that results in corneal swelling. It is a genetically inherited disease that occurs more commonly in women and the elderly. A person born with this disease may remain asymptomatic till adulthood.
Fuchs’ dystrophy can lead to symptoms such as glare, eye discomfort, and cloudy vision. Blurred vision in the morning that gets better as the day progresses is the first sign of this disorder. Over time, the visual acuity deteriorates, and individuals become increasingly sensitive to bright light.
The function of corneal endothelial cells is to maintain the fluid balance for transparent cornea and clear vision by pumping excess fluid out of the cornea.
The function of corneal endothelial cells is to maintain the fluid balance for transparent cornea and clear vision by pumping excess fluid out of the cornea. Fuchs’ endothelial dystrophy is caused by the destruction of corneal endothelial cells.
In Fuchs’ dystrophy, the endothelial cells get distorted, causing fluid buildup in the cornea, which results in corneal edema and vision impairment. Later on, the corneal epithelium also gets affected causing swelling, blisters, subepithelial scarring, and severe vision impairment.
- Genetics: Individuals with a family history of Fuchs’ dystrophy are at increased risk of having the disorder.
- Gender: Women are more likely to suffer from Fuchs’ dystrophy as per epidemiological studies that have found this condition to be more common in women than in men.
- Age: Increasing age is an important risk factor for Fuchs’ dystrophy as this disorder typically starts in late adulthood with a relatively rapid progression afterward.
- Smoking: Smokers are at a significantly greater risk of developing this disease in comparison to non-smokers.
Fuchs’ endothelial dystrophy is generally diagnosed during routine eye exams. An ophthalmologist may perform the following examinations for a confirmatory diagnosis:
- Slit-lamp microscopy
- Specular microscopy
Depending on the stage or progression of the disease, treatment for Fuchs’ endothelial dystrophy ranges from eye drops or ointment to surgical procedures.
- 5% sodium chloride drops and ointment: Hypertonic saline drops and ointments help draw fluid out of the cornea and can thereby reduce corneal edema via osmosis.
- Soft contact lenses: These can keep the eye comfortable in the presence of bullae (bullous keratopathy), which is a sequelae of endothelial dystrophy.
- Keeping the eyes dry: Blow drying the eyes with warm air with a hairdryer a few times a day may help dry out blisters and reduce excess fluid buildup.
- Keratoplasty: DSEK (Descemet’s Stripping Endothelial Keratoplasty) may be necessary for the late or end stages of Fuchs’. As this procedure replaces only part of the stromal layer along with Descemet’s membrane and inner endothelial layer, it can preserve the healthy corneal portion, speed up healing, and reduce the chance of graft failure. The more advanced DMEK (Descemet’s Membrane Endothelial Keratoplasty) replaces only Descemet’s membrane and the inner endothelial layer with stromal transplantation. This procedure, albeit more challenging to carry out than DSEK, allows for better post-op visual acuity.