Fuch’s Dystrophy

Fuch’s dystrophy is a slowly progressing disease that usually affects both eyes and is slightly more common in woman than men.  Although doctors can often see early signs of Fuch’s dystrophy in people in their 30’s and 40’s, the disease rarely affects vision until people reach their 50’s and 60’s. 

Fuch’s dystrophy occurs when endothelial cells gradually deteriorate without any apparent reason.  As more endothelial cells are lost over the years, the endothelium becomes less efficient at pumping the water out of the stroma.  This causes the cornea to swell and distort vision.

Eventually, the epithelium takes on water, resulting in pain and severe visual impairment.  Epithelial swelling damages vision by changing the cornea’s normal curvature, and causing a sight-impairing haze to appear in the tissue.  Epithelial swelling will also produce tiny blisters on the corneal surface.  When these blisters burst, they are extremely painful.

At first, a person with Fuch’s dystrophy will awaken with blurred vision that will gradually clear throughout the day.  This occurs because the cornea is normally thicker in the morning; it retains fluid during sleep that evaporates in the tear film while we are awake.  As the disease worsens, this swelling will remain constant and reduce vision throughout the day.

When treating the disease, doctors will try to reduce the swelling with drops, ointments, or soft contact lenses.  They may also instruct a person to use a hair dryer, held at arm’s length or directed across from the face, to dry out the epithelial blisters.  This can be done two or three times a day.

When the disease interferes with daily activities, a person may need to consider having a corneal transplant to restore sight.  The short-term success rate of a corneal transplantation is quite good for people with Fuch’s dystrophy however; some studies suggest that the long-term survival of the cornea can be a problem.