Fuchs’ Corneal Dystrophy: Causes, Systems, and Treatment

What is Fuchs’ corneal dystrophy?

Fuchs’ corneal dystrophy is a disorder of the cornea (front surface of the eye). It can be explained as an eye disease that harms the innermost layer of cells in the cornea. This layer is known as the endothelium. The endothelium is mainly responsible for maintaining the proper amount of fluid in the cornea. The endothelium layer contributes to keeping the cornea clear for good vision. As it pumps out excessive fluid that can cause corneal swelling.

Usually, this disease affects both eyes and results in a gradual decline in vision due to corneal swelling (edema) and clouding. As the disorder grows, swelling of the cornea causes blisters on the front part of the cornea which is known as epithelial bullae. And this condition is known as bullous keratopathy. The prevention of Fuchs’ Corneal disease is unknown.

Old-age people are more prone to this disorder. Due to this disease, the cells in the corneal layer known as the endothelium gradually die. These cells function to pump fluid from the cornea to keep it clear. When the cells die, fluid starts building up and the cornea gets swollen and puffy. Vision becomes hazy and cloudy.

Stages of Fuchs’ corneal disease

• During the first stage, vision is blurry in the morning period
• In the second stage, vision remains hazy all day long.

This disease starts growing in people from their 30s-40s but people get to know about it at a very late stage. There are no symptoms of this disease during the initial stage. Fuchs’ Corneal disease starts showing its symptoms around the age of 50s. The family history of Fuchs’ corneal disease increases the risk of developing this disease.

Stage I

 In the initial stage of this disease, a few symptoms may appear. Your vision may get hazy and blurry when you wake up in the morning. But it gradually improves throughout the day. This happens because your eye naturally remains moist during your sleep. But when you wake up this fluid dries off.

Stage II

This is the later stage when your vision starts getting blurry and hazy and it does not improve as the day goes on. Fluid during your sleep builds up a little more than the usual amount and it does not dry up when you are awake. The formation of tiny blisters may be witnessed around your cornea. These blisters grow bigger over time and eventually break up which causes pain in the eye. 

Symptoms of Fuchs’ corneal dystrophy

1. Eyes may feel sandy and gritty.
2. People may witness extra sensitivity to bright light
3. Eye problems may get worse in areas with high humidity.
4. Due to scarring at the center of the cornea, the vision may get blurry and hazy.
5. Colored halos may appear around the eyes.
6. Vision during the night may get worse.
7. Foreign body sensation- feeling something is in your eyes.

FUCHS’ Corneal dystrophy with cataract

Cataracts are a normal part of aging. Cataract leads to a gradual clouding of the eye lens, which can be corrected by cataract surgery.

There are possibilities of developing cataracts on top of Fuchs’ dystrophy. In this case, you would be needing two surgeries at once: cataract removal and corneal transplant. This is because cataract surgery can damage already-sensitive endothelial cells which is a symptom of Fuchs’ corneal dystrophy.

Who is more prone to Fuchs’ dystrophy?

People who are in the age group of 40-50 are more likely to be affected by this disease. Also, Women are more prone to this disease in comparison to men. Eye check-ups can detect early symptoms of this disease in younger adults. The family history of Fuchs’ corneal dystrophy increases the risks of this disease developing in people.

Precautions for Fuchs’ corneal disease

If diagnosed with Fuchs’ Corneal Dystrophy, make sure you discuss this with your eye doctor. In case you are considering LASIK surgery or other refractive surgery or in case you have cataracts and need cataract surgery. These surgeries can worsen the condition. And corneal dystrophy often is considered a contradiction for refractive surgery.

It is a progressive disease. If detected in its earlier stages, vision problems can be prevented. This disease shows hardly any symptoms in its early stage; therefore, you need to visit your ophthalmologist or your optometrists for a comprehensive exam on monthly basis. If you are noticing any of these symptoms visit your doctor before the disorder grows any further.

Diagnosis of Fuchs’ corneal dystrophy

Diagnosis of the eyes

 A lamp called ‘slit lamp’ is used for the diagnosis of the eyes. This instrument performs a detailed examination of the cornea. During this exam, he/she will inspect the cornea under high magnification to look for any degenerative changes in the cells in the endothelium which is a symptom of this disease.

corneal guttata

The early clinical signs of Fuchs’ Corneal Dystrophy are a decreased number of endothelial cells and small drop-like lesions in the corneal endothelium known as corneal guttata.

your corneal thickness

Your eye doctor may perform another test for measuring your corneal thickness (pachymetry), which will help to detect increased corneal thickness indicating corneal swelling caused by the disease.

Visual Acuity test

The visual acuity test performed during the comprehensive exam can detect decreased vision due to corneal swelling.

Treatment of Fuchs’ corneal dystrophy

Home remedies

There are few ways to naturally treat Fuchs’ corneal dystrophy. You can take a few steps to minimize symptoms. You can blow-dry your eyes with the dryer set on low a few times per day. This will help keep your cornea dry. Over-the-counter sodium chloride drops can also help with this condition.

Medical treatment

The treatment for Fuchs’ Corneal Dystrophy will depend on the stage of the disorder. In the initial stage, vision can be improved by removing excessive water from the cornea with sodium chloride (hypertonic) eye drops.

For reducing your sensitivity to sunlight, eyeglasses with photochromic lenses can prove helpful. Anti-reflective coating can eliminate reflections in the eyeglass lenses that may bother people suffering from Fuchs’ corneal dystrophy.

People suffering from endothelial dystrophy and ocular hypertension are recommended the “glaucoma eye drops” by their eye doctor to reduce intraocular pressure (IOP). If the pressure on your eye is high, it may damage the corneal endothelium and worsen Fuchs’ dystrophy.

As the disease grows, epithelium bullae will be ruptured which will cause painful corneal abrasions and poor vision. If the vision is lost considerably due to Fuchs’ dystrophy, then a corneal transplant is usually needed.

An alternative to a corneal transplant is deep lamellar endothelial keratoplasty (DLEK). It is a surgical method to replace the endothelium. This procedure has been proved successful for the treatment of Fuchs’ dystrophy and it has fewer risks than penetrating keratoplasty.

Recently, an advanced form of DLEK called “Femtosecond laser-assisted Descemet stripping endothelial keratoplasty (FS-DSEK)” has shown great results for the treatment of the disease.

Visit an ophthalmologist or an optometrist for a comprehensive eye exam. This disease can only be detected through an eye exam.

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