Fuchs Endothelial Dystrophy is an eye condition that isn’t commonly spoken of, and certainly doesn’t effect as many people as some of the major blinding eye diseases that you hear of quite frequently. But we’ve met plenty of patients with Fuchs so I thought it would be beneficial to cover it in detail for everyone who might be interested.
Fuchs Endothelial Dystrophy affects the cornea, which is the front window of the eye, that contains three very important layers: the epithelium, the stroma and the endothelium.
The Layers
You’ve got the epithelial layer that sits at the front, it’s the most superficial layer, like your skin and when it peels away, that front layer of the cornea recycles quite frequently. Meaning it regrows and comes back quite quickly to replenish itself.
The middle layer is the stroma which we consider the bulk of the cornea and certainly the thickest layer.
Behind the stroma you have the endothelium which is this really fine, single layer of cells that sits at the back of the cornea. The role of the endothelium is to ensure that there’s no fluid within the cornea as the cornea needs to be dry to be transparent, or see-through, because when it’s not see through it seriously affects your vision. If you’d like you can imagine your vision like a window and if it isn’t clear, clean and dry it is like looking through frosted glass. The endothelium at the back makes sure that there’s no fluid present by pumping fluid out of the cornea and inside the eye and with Fuchs endothelial dystrophy this layer breaks down, meaning that it does not work efficiently.
What Happens?
You lose the pumps which means you lose the ability to take the fluid out of the cornea and it means the cornea becomes hazy or cloudy, as it loses its transparency. Often people with Fuchs endothelial dystrophy wake up with quite cloudy or foggy vision and the mornings are especially an issue because during sleep there’s less pump activity naturally, so more fluid seeps into the cornea. When you wake up, the pumps get going and the cells start pumping the fluid out and then through the middle of the day towards the end of the day, the vision is much better. So often these people tend to think “oh, my vision is not terrible, it’s just in the mornings it’s a bit foggy and hazy and it takes me quite some time for my vision to return to normal.” However, it takes a lot longer to even begin to clear up if you have Fuchs. Another frequent complaint for patients with Fuchs is having halo rings around lights, and this is due to light scatter through the “frosted glass” of your vision as opposed to “clear glass” and it can be quite bothersome.
Management
If Fuchs is not managed properly you can end up with excess fluid creating blisters in the cornea. If these blisters make it to the surface and rupture, it can be quite painful. Management can be helpful, and there are some eye drops on the market for these symptoms but quite often these people need corneal grafts as management with eye drops is not always sufficient. A corneal graft transplant involves taking a donor corneal endothelium from someone who doesn’t have the condition and using it to replace those pumps that are no longer working in a patient with Fuch’s Dystrophy. So it’s quite an interesting condition, and can be difficult to diagnose without proper investigation, and can be quite visually disabling and frustrating. If you’re interested in hearing more about this condition, you can come in and have a chat and we’ll be able to discuss it further.
Wes Butler- Optometrist
Video on Fuchs Dystrophy: https://player.vimeo.com/video/471223882
