Fuchs' dystrophy

Fuchs' dystrophy is an eye disease that affects a layer of cells in the cornea. It's also known as Fuchs' endothelial corneal dystrophy. It can cause vision problems such as cloudy, blurred vision and sensitivity to light.

Fuchs' dystrophy typically affects both eyes. The condition mainly affects adults in their 40s, especially women (Source: Molecular Vision). However, it may not lead to vision problems until years later.

Wearing dark glasses and using eye drops can alleviate symptoms. Corneal transplant surgery may be a treatment option for people whose vision is more seriously affected.

Fuchs' dystrophy symptoms

People with Fuchs' dystrophy may not initially have symptoms. It's an eye disease that progresses slowly, and some people never experience vision problems.

Symptoms of Fuchs' dystrophy occur when the layer of endothelial cells in the cornea is damaged. When these cells don't work correctly, fluid can't be cleared from the cornea, leading to swelling and symptoms including:

• Cloudy or blurred vision that makes it harder to see clearly.
• Glare, making it harder to see in bright light and causing you to see halos around lights.
• Sensitivity to light that may be worse at night.
• Quality of vision that changes through the day, usually worse in the morning and improving as the day goes on.
• Eye pain and a gritty feeling in the eyes if blisters are present.
• Reduced contrast sensitivity. This makes it harder to see objects without a high contrast of differing colours.
• If one eye is affected more than the other, your depth perception may be affected.
• Symptoms can be worse in humid conditions.

At an early stage of the disease, you might have blurred vision upon waking in the morning due to fluid build-up in the cornea overnight. Your vision will likely improve through the day as the fluid clears from your eyes.

At a later stage, your vision may stay affected if the corneal swelling doesn't improve during the day. Sometimes, the outer layer of the cornea, the epithelium, becomes swollen, which can cause the eyes to feel gritty and sore. The cornea can develop blisters called 'bullae' (a condition known as bullous keratopathy). These can make you more sensitive to light, contribute to deteriorating vision (because they affect the shape of the cornea's surface), and they're painful when they burst.

Fuchs' dystrophy treatment

If you have no symptoms or if they're mild, you may not need treatment for Fuchs' dystrophy. You'll still need regular eye exams for your optician to monitor the progress of your condition.

At an early stage, symptoms can often be managed by:

• Using sodium chloride eye drops to help clear excess fluid from the cornea.
• Gently blowing warm air onto your face with a hairdryer to dry the cornea.
• Wearing tinted eyeglasses or photochromatic lenses that go dark in bright light to reduce glare.

If you develop corneal blisters, medicine can relieve the pain. Soft contact lenses worn day and night can also relieve pain and promote healing.

If you also have glaucoma, you may need eye drops to lower the high pressure in your eye. This is because glaucoma can affect the corneal endothelium as well.

If significant vision problems begin to affect your daily life, a corneal transplant may be an option. Your ophthalmologist can discuss this with you, including the different types of surgery.

What causes Fuchs' dystrophy?

Fuchs' dystrophy affects the endothelial layer of cells inside the cornea at the front of the eye. Endothelial cells play a role in the cornea's health, maintaining the right fluid balance to prevent swelling and clear the cornea.

When you have Fuch's dystrophy, endothelial cells are either lost or stop working correctly, leading to fluid build-up and swelling of the cornea.

Fuchs' dystrophy can be sporadic (with no family history of the condition) or inherited if there is a family history of Fuchs' dystrophy. Fuchs' dystrophy is more common in women than men. It usually develops in adults, but a very rare type of early-onset Fuchs' dystrophy can affect children.

Getting a Fuchs' dystrophy diagnosis

Your optician may diagnose Fuch's dystrophy at a routine eye test because it's common for the condition to develop for many years without causing noticeable symptoms.

Fuchs' dystrophy can be diagnosed by closely examining the back layer of the cornea. Your optician may do the following tests to diagnose Fuchs' dystrophy:

• Use a slit lamp to examine your eye and look for irregular bumps (guttae) at the back of the cornea.
• Measure the corneal thickness with a corneal pachymetry test.
• Take a photograph of the cornea (called tomography).  

An optician can refer you to an ophthalmologist if you need help with symptoms.

When to get medical advice

The NHS recommends that we have an eye test every two years. Opticians check your eye health and detect some eye conditions before symptoms develop, including Fuchs' dystrophy.

If you have Fuchs' dystrophy and notice any sudden changes in your vision, see your optician or ophthalmologist.