Fuch’s Corneal Dystrophy Eye Problems

Dr. Kisling Uncategorized Leave a Comment

Fuch’s dystrophy is an eye condition effecting the clear corneal tissue covering the colored part of the eye. The cornea is an incredible tissue measuring only ½ mm thick with layers of collagen aligned precisely to allow for transparency. It is separated into five regions, the posterior most being the layer of endothelial cells. The endothelial cells function to keep the cornea from being inundated with water. Accumulation of water results in swelling and haziness that blurs vision. Normally the cornea is about 70% water, exceeding the fluid content of most contact lenses. If the endothelial cells start to lose their capacity to pump water back out of the cornea, the fluid content starts to rise above 70% and the cornea begins swelling. Above 4% swelling the aftermath is haze and fogging of vision. In a healthy eye during sleep the eyelid serves as a barrier to oxygen flow and the cornea swells 3-4% overnight. The criteria for oxygen permeability of overnight wear contact lenses is to stay close  to the 3-4% swelling and avoid the complications that accompany the accumulation of water in the cornea. 

Cornea Blisters Fuch's


In Fuch’s Dystrophy The Cornea Determines How Well You See. The endothelium lines the deepest surface of the cornea and normally new cells do not grow to replace damaged or aging cells. This makes the endothelial cells vitality critical for clear vision. Age reduces the number of cells present as does most types of eye surgery. In Fuch’s, the endothelial cells reach a critical point where they have decreased to an inadequate number and/or no longer work well enough to keep the aqueous fluid inside the eye from overwhelming the corneal tissue. Typically this happens at age 50+ and seems to be much more frequent in women. There is a genetic component. The initial damage starts from growth like bumps secreted by the endothelium called guttata. These abnormal accumulations of tissue distress Descemet’s membrane and the endothelial cells. Eventually the effect spreads to the surface of the eye where blisters and fluid accumulation result in poor vision and discomfort.

Early Treatment of Fuch’s by Eye Doctors includes hypertonic eye drops that draw the fluid out of the cornea. Mildly warm air blowing on the cornea at arms length from an air dryer has also been used to dry out the cornea. In the advanced stages of Fuch’s Dystrophy corneal surgery may be required to restore vision. In the past, the cornea was removed to a deep level and a donor circle of cornea was sutured back in place. Today, new procedures that are much less invasive are becoming widespread. Descemet’s stripping with endothelial keratoplasty (DSEK) has become very well accepted and has very good results. Descemet Membrane Endothelial Keratoplasy (DMEK) is another new procedure that trnasplants Descemt’s Membrane and the endothelium. These new procedures are improving outcomes in patients with Fuch’s and giving new hope for tomorrows vision.

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