A corneal dystrophy is a bilateral (both eyes) abnormality occasionally present at birth but more frequently appearing later in life. Any of the five layers of the cornea can be involved. Of the many known dystrophies, the one most commonly encountered in clinical practice is Fuchs’ Corneal Dystrophy.
Fuchs’ dystrophy is an inherited eye disease that causes the cells in the endothelium, the last layer of the cornea, to deteriorate. This leads to distorted vision and corneal swelling (corneal edema). The exact cause of Fuchs’ dystrophy is unknown, but is believed to be a combination of hereditary, hormonal and inflammatory factors. This condition affects both eyes and is more common in women than men.
The cornea is made up of five different layers, each of which has a specific function that controls vision. The endothelium is the back layer of the cornea, which removes excess fluid from the cornea. Excess fluid can cause the cornea to swell and vision to become distorted. Occasionally the swelling can become so severe that bullae (blister-like lesions) will develop that can result in pain. Once endothelial cells are lost, they do not grow back, so this condition will continue to progress with time.
Although this condition is inherited, symptoms do not usually appear until the patient is over the age of 50. Patients with Fuchs’ dystrophy may experience blurred vision as the first sign of this condition. Blurred vision occurs in the morning as a result of fluid accumulating in the cornea while you sleep. As this fluid evaporates throughout the day, vision may improve. Progressive swelling and thickening of the cornea may also lead to painful erosions and difficulty recovering from cataract surgery. Other symptoms of Fuchs’ dystrophy may include:
- Sensitivity to bright lights
- Halos around lights
- Poor night vision
- Sharp pains in the eyes
- Sandy, gritty sensation in the eyes
- Fluctuating vision
While there is no cure for Fuchs’ dystrophy, there are several treatment options available to help relieve the symptoms of this condition and to prevent permanent damage. In its early stages, Fuchs’ dystrophy can often be treated with a salt solution to remove fluid from the eye and reduce swelling. In more advanced stages, Fuchs’ dystrophy may begin to interfere with daily activities and prevent patients from functioning normally. In this stage, patients may require a corneal transplant to replace the cornea with full, thick layers that allows them to see clearly. The DSAEK procedure is an innovative, new, partial corneal transplant procedure performed on an out-patient basis.