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Fuchs' Dystrophy

What is Fuchs' dystrophy?

It is a disease of the innermost layer of cells of the cornea (clear window of the eye), the endothelium. These cells normally keep the cornea clear by pumping excess fluid out. When they die the cornea contains too much fluid and swells. This results in cloudy or hazy vision.

Corneal Structure Corneal Structure

What causes Fuchs' dystrophy?

In many cases the cause is unknown. Sometimes there is a family history but it can also occur without any previous family history of the disease. If your mother or father has Fuchs' dystrophy you have about a 50% chance of getting the disease. It is more common among woman than men. There is no known prevention for Fuchs' dystrophy.

What are the symptoms of Fuchs' dystrophy?

Fuchs' Dystrophy is usually diagnosed at about 50 years of age, as this is when it starts causing vision problems. People in their 30's and 40's have few visual symptoms. Symptoms include hazy vision in the morning that gets better during the day. The reason is that fluid builds up in the cornea when you keep your eyes closed to sleep. During the day your corneas dries when your eyes are open. Later too much fluid builds up and cannot dry during the day and your vision stays blurry all day. Blisters form in the cornea that get bigger and eventually break. This can cause scarring of the cornea.

Other symptoms include:

  • Glare and sensitivity to light
  • Eye pain from the tiny blisters that form
  • Foggy or blurred vision from scarring of the corneae
  • Difficulty seeing at night
  • Poor vision upon awakening that may improve later in the day
  • A sandy feeling in your eye

Corneal Structure

An eye with a normal cornea. The clear window at the front of the eye.

Corneal Structure

Fuchs' dystrophy with blisters forming due to excessive fluid.

How is Fuchs' dystrophy diagnosed?

To detect Fuchs' dystrophy you need a comprehensive eye exam. Your Ophthalmologist will measure the thickness of your cornea using Pachymetry. Increased thickness could be due to swelling. He will also look for tiny blisters. A special photograph of your cornea could also be used to count your endothelial cells. You may also have decreased visual acuity when tested with an eye chart.

How is Fuchs' dystrophy treated?

It cannot be cured. The aim is to control the visual symptoms of the disease.

Treatment options for Fuchs' dystrophy:

Eye drops can be used to reduce swelling of the cornea.

A hair dryer can be used, held at arms length, to blow warm air in your face. It helps to dry the cornea and reduce swelling.

If you have very poor vision or corneal scars, you may need a corneal transplant. The first option is a Descemet’s membrane endothelial keratoplasty (DMEK), a surgical method to replace the endothelium that leaves the upper layers of the cornea untouched.

Another option is a full thickness corneal transplant where the center of your cornea is replaced with a healthy donor cornea.

Tell your eye surgeon!

If you have been diagnosed with Fuchs' corneal dystrophy discuss this with your eye doctor if you are considering refractive surgery or if you have cataracts and need cataract surgery. These eye surgeries can worsen the condition, and corneal dystrophy often is considered a contraindication for elective refractive surgery.