Fuch's Dystrophy

1 What is Fuch's Dystrophy?

Fuch's dystrophy is a condition that causes swelling in the cornea. The cornea is the clear front window of the eye.

This swelling can lead to glare, cloudy vision and discomfort in th eye. This disorder usually affects both eyes and causes vision to worsen over many years.

However, most cases of Fuch's dystrophy are mild and are not accompanied by changes with vision. It affects more women than it affects men.

Medications and self-care tips can help to relieve the signs and symptoms in mild cases.

Severe cases, in which vision is lost, require cornea transplant surgery.

2 Symptoms

Signs and symptoms of Fuch's dystrophy include:

  • Glare, which reduces perception or affects vision in low light.
  • Blurred vision, which usually occurs in the morning and gradually improves during the day. As the disease progresses it can take longer periods of time for the vision to improve.
  • Distorted vision, sensitivity to light, problems with night vision and seeing halos around light.
  • Painful, tiny blisters on the surface of the cornea.
  • A cloudy or hazy cornea.
  • Irregular bumps on the surface of the cornea (guttae)
  • Swollen cornea
  • Thickening of the cornea

3 Causes

Fuch's Dystrophy is caused by fluid gathering in the cornea.

Under normal conditions, the endothelial cells that line the cornea prevent fluids from accumulating within the cornea. This prevents the cornea from swelling and looking cloudy.

In Fuch's dystrophy these endothelial cells die off slowly and do not function properly leading to fluid accumulation within the cornea. This leads to the thickening of the cornea and burry vision.

Fuch's dystrophy can be inherited since it can occur in individual with a family history of the disease.

4 Making a Diagnosis

The following tests can help doctors (ophthalmologists) to diagnose Fuch's dystrophy:

  • Visual acuity test, in which the patient is asked to read letters and numbers on a chart to measure how well the patient can see and various distances.
  • Staging-determing the stage of the condition by examining the eye with an optical microscope (slit lump). This helps doctors to check if there are any pumps (guttae) on  surface of the cornea.
  • Cornea pressure test, in which the pressure of the eye is tested. Doctors usually place eye drops that numb the eye and measure the pressure in the eye by briefly touching the cornea with a special instrument.
  • Corneal thickness- which is measured by a special instrument.
  • Corneal cell count- doctors use a special instrument to record the number, shape and size of cells lining the cornea.

5 Treatment

Treatment for Fuch's dystrophy depends on the severity of the disorder. While mild cases require nonsurgical treatments, severe cases may require surgery.

Nonsurgical treatments include:

  • Eye drops or ointments that can help to reduce the amount of fluid in the cornea.
  • Soft contact lenses that can act as a "bandage" to relieve pain by smoothing out microscopic swelling on the cornea.

Surgical procedures for Fuch's dystrophy include:

  • Replacing the inner  layer of the cornea. In this procedure only the back of the cornea is replaced with healthy tissue from a donor. It is performed under local anaesthesia in an outpatient setting.Two techniques can be used; Descemet stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK).
  • Penetrating keratoplasty , in which the entire cornea is replaced with a healthy one from a donor.                                                                                                                                                                 

6 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with Fuch's dystrophy.

The following techniques can help reduce glare and eye discomfort:

  • Applying over-the-couter salt solution (5 percent sodium chloride eyedrops or ointment).
  • Wearing wraparound, ultraviolet protection sunglasses.
  • Drying the eyes with a hair dryer as this can remove the excess fluid in the eye. It also helps to dry out microscopic swelling and blisters on the surface of the cornea. The hair dryer should be place at arm's length. Warm and not hot air should be directed across the face. This can be done two to three times daily.

Joining a support group can help people living with Fuch's dystrophy to cope with this condition.

7 Risks and Complications

The risks factors of developing Fuch's dystrophy include:

  • Being female
  • Having a family history of Fuch's dystrophy
  • Being older than 50