Dr. Orwa Nasser MD MPH - Fuchs Dystrophy

Fuchs Dystrophy

Fuchs dystrophy is a progressive corneal disease that affects the innermost layer of the cornea known as the endothelium. Endothelial cells normally pump excess fluid out of the cornea to maintain clarity. When these cells deteriorate, fluid accumulates in the cornea and causes swelling and blurred vision. The condition usually affects both eyes and progresses slowly over time.

Symptoms: Symptoms typically develop gradually and may be more noticeable in the morning.

    ·    Blurred or hazy vision.

    ·   Sensitivity to light.

    ·    Glare or halos around lights.

    ·    Difficulty seeing in low light.

    ·    Frequent changes in glasses prescription.

    ·    Eye irritation or dryness.

    ·    Advanced cases may develop painful corneal bullae due to significant swelling.

Causes: Fuchs dystrophy is caused by progressive loss of corneal endothelial cells. The exact reason for cell loss is not fully understood. Genetic predisposition plays a role in many cases. The condition is more common in women and increases with age.

Diagnosis and Tests: Diagnosis is made through comprehensive eye examination. Slit-lamp examination allows evaluation of corneal clarity and endothelial changes. Specular microscopy measures endothelial cell density. Pachymetry assesses corneal thickness and detects edema. Monitoring over time helps determine progression.

Management and Treatment: Treatment depends on severity and symptom impact.

·    Surgical treatment: Endothelial keratoplasty such as Descemet’s Stripping Endothelial Keratoplasty or Descemet’s Membrane Endothelial Keratoplasty is performed to replace the damaged endothelial layer. These procedures selectively replace diseased tissue and often allow faster recovery than full-thickness transplant. Corneal transplantation is considered when swelling significantly affects vision or causes pain.

·    Early-stage management: Lubricating drops may relieve irritation. Hypertonic saline drops or ointment may reduce corneal swelling.

·    Intermediate management: Specialized contact lenses may improve visual quality. Prescription updates may be needed as vision changes.

Prognosis:

·    The progression of Fuchs dystrophy varies between individuals.

·    Many patients maintain functional vision for years.

·    Advanced disease may significantly reduce vision if untreated.

·    Modern endothelial keratoplasty techniques have improved long-term outcomes.

Prevention:

·    There is no known method to prevent Fuchs dystrophy.

·    Regular eye examinations allow early detection and monitoring.

·    Individuals with family history should consider periodic screening.

When Should I See My Healthcare Provider? Seek evaluation if you notice persistent blurred vision, morning haze, glare, or increasing light sensitivity.

When Should I Go to the Emergency Room? Go immediately if you experience sudden severe eye pain, rapid vision loss, or signs of infection.

What Questions Should I Ask My Healthcare Provider?

    ·    How advanced is my endothelial cell loss?

    ·    How often should I be monitored?

    ·    What treatments can improve my vision?

    ·    Am I a candidate for endothelial keratoplasty?

    ·    What is the expected recovery timeline after surgery?

Key Takeaways:

    ·    Fuchs dystrophy is a progressive loss of corneal endothelial cells.

    ·    It leads to corneal swelling and blurred vision.

    ·    Morning haze is a common early symptom.

    ·    Treatment ranges from supportive care to endothelial keratoplasty.

    ·    Regular monitoring improves long-term outcomes.