Fuchs Dystrophy is a slowly progressive disease that results in swelling of the cornea and blurred vision. It is more common in women than men. While it is possible to observe Fuchs Dystrophy in people in their 30’s and 40’s, it usually does not compromise vision until people are in their 50’s or 60’s. The innermost layer of cells in the cornea, called the endothelium, is a single layer of non-regenerating cells. The endothelial cells are responsible for pumping water out of the cornea and helping to maintain the corneal transparency. While the reason is poorly understood, in Fuchs Dystrophy, the endothelial cells slowly die over time. The progressive loss of the endothelium makes it difficult to remove water from the cornea. This results in the cornea swelling and blurred vision. In its later phases, Fuchs Dystrophy is often associated with considerable pain as the epithelium “blisters” by forming “bullae”, which actually begin to burst open. Early in the course of Fuchs Dystrophy patients will wake up with blurry vision that gets progressively clearer as the day passes. As the Fuchs Dystrophy disease worsens, the vision does not clear we will attempt to help reduce the corneal swelling each day with eye drops and ointments. However, when these measures fail to provide comfort and clear vision, it may be necessary to have a corneal transplant procedure called DSEK or DMEK to transplant endothelial cells, which may help certain Fuchs Dystrophy patients overcome their discomfort and vision problem.
The outermost layer of the cornea, called the epithelium, is attached or anchored to an underlying basement membrane, called Bowman’s Membrane, in order to remain healthy. Sometimes the epithelial basement membrane develops abnormally making it difficult or impossible for the epithelium to adhere properly to the basement membrane. If the epithelium does not adhere properly, Recurrent Corneal Erosions will occur. Recurrent Corneal Erosions are painful and cause the corneal surface to become irregular resulting in intermittent blurry vision along with the discomfort and foreign body sensation. Map-Dot-Fingerprint Dystrophy is also known as Epithelial Basement Membrane Dystrophy because it is caused by a lack of the healthy formation of the Basement Membrane. It affects adults between the ages of 40-70 and can sometimes begin earlier. As the name implies, its appearance is of a map of gray areas, which may also be accompanied by opaque dots, and fingerprint like whirls or lines. We will often discover Map-Dot-Fingerprint Dystrophy during a routine eye examination in patients who do not have any noticeable symptoms. If treatment is required to control the pain for those patients who are symptomatic, we may prescribe lubricating eye drops, patch the eye, apply a soft bandage contact lens or in more severe cases, scrape the cornea to attempt to achieve better adhesion of the epithelium. In some cases, Drs. Michelson may suggest that the best results can be achieved using Excimer Laser Phototherapeutic Keratectomy (PTK) to smooth the surface of the cornea.
Lattice Dystrophy is an inherited condition that occurs as a result of the accumulation of abnormal protein fibers, or amyloid deposits in the middle cornea layer called the corneal stroma. If these deposits become dense enough they will become opaque and affect the corneal transparency so that vision is reduced. If these deposits occur under the outermost layer, the epithelium, they can cause recurrent erosions of the cornea, which can be painful and disturb the normal corneal curvature, effecting vision.
In instances where there are recurrent corneal erosions and pain, Drs. Michelson may prescribe eye drops, ointments and occasionally an eye patch or bandage soft contact lens. Early Lattice Dystrophy seems to respond well to Excimer Laser Phototherapeutic Keratectomy (PTK) whereas more serious cases may require a corneal transplant.