Fuchs’ dystrophy is an inherited
condition that affects the delicate inner layer (endothelium) of the cornea. The endothelium functions as a pump
mechanism, constantly removing fluids from the cornea to maintain its
clarity. Patients gradually
lose these endothelial cells as the dystrophy progresses. Once lost, the endothelial cells do
not grow back, but instead spread out to fill the empty spaces. The pump system becomes less
efficient, causing corneal clouding, swelling and eventually, reduced
In the early stages, Fuchs’ patients
notice glare and light sensitivity. As the dystrophy progresses, the vision may seem blurred in
the morning and sharper later in the day. This happens because the internal layers of the cornea tend to retain
more moisture during sleep, that evaporates when the eyes are open. As the dystrophy worsens, the vision
becomes continuously blurred.
Fuchs’ affects both eyes and is slightly
more common among women than men. It generally begins at 30-40 years of age and gradually
progresses. If the vision
becomes significantly impaired, a corneal
transplant may be indicated. Sometimes
corneal transplant (also known as penetrating keratoplasty or PKP) is
performed along with cataract and intraocular lens implant
Signs and Symptoms
- Hazy vision that is often most pronounced in the morning
- Fluctuating vision
- Glare when looking at lights
- Light sensitivity
- Sandy, gritty sensation
Detection and Diagnosis
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.
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 the vision.
Corneal transplant is indicated when the vision deteriorates to the
point that it impairs the patient’s ability to function normally.
This is a highly magnified photo of the layers of the cornea.
The "oedema" caused by Fuchs' can be seen as the mottled appearance.