Diagnosis

Besides testing your vision, your doctor might also have you undergo the following tests to determine whether you have Fuchs' dystrophy:

  • Cornea examination and grading. Your doctor will make the diagnosis of Fuchs' dystrophy by examining your eye with an optical microscope (slit lamp) to look for irregular bumps (guttae) on the inside surface of the cornea. He or she will then assess your cornea for swelling and stage your condition.
  • Corneal thickness. Your doctor might use a test called corneal pachymetry to measure the thickness of the cornea.
  • Corneal tomography. Your doctor might obtain a special photograph of your cornea (tomography) to assess for early signs of swelling in your cornea.
  • Corneal cell count. Sometimes your doctor might use a special instrument to record the number, shape and size of the cells that line the back of the cornea. However, this test is not required.

Treatment

Some nonsurgical treatments and self-care strategies might help relieve the symptoms of Fuchs' dystrophy. If you have severe disease, your doctor might suggest surgery.

Medications and other therapies

  • Eye medication. Saline (5% sodium chloride) eyedrops or ointments can help reduce the amount of fluid in your cornea.
  • Soft contact lenses. These act as a covering to relieve pain.

Surgery

People who have surgery for advanced Fuchs' dystrophy can have much better vision and remain symptom-free for years afterward. Surgical options include:

  • Transplanting the inner layer of the cornea. Known as Descemet membrane endothelial keratoplasty (DMEK), this procedure involves replacing the back layer of the cornea with healthy endothelial cells from a donor. The procedure is usually done with local anesthesia in an outpatient setting.
  • Transplanting the cornea. If you have another eye condition or have had previous eye surgery, DMEK may not be an option. Your doctor may recommend a partial-thickness cornea transplant, a procedure known as Descemet-stripping endothelial keratoplasty (DSEK). Rarely, a full-thickness cornea transplant, known as penetrating keratoplasty (PK), may be recommended.

Potential future treatments

A variety of new treatments are being investigated that could change how Fuchs' dystrophy is managed in the future. After the genetic abnormality associated with most cases of Fuchs' dystrophy was discovered, there is a better understanding of how the disease might develop, and this offers the potential for nonsurgical therapies in the future. Various eyedrop treatments are being developed and may enter clinical trials in the future. Novel surgical treatments also are being studied to determine if they may be of benefit.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

In addition to following your doctor's instructions for care, you can try these techniques to help reduce glare or soothe your eyes.

  • Apply over-the-counter (nonprescription) salt solution (5% sodium chloride) eyedrops or ointment.
  • Dry your eyes with a hair dryer. Hold it at arm's length and direct warm — not hot — air across your face, especially in the morning when swelling is worse. This helps remove excess fluid in the cornea, which decreases swelling.

Preparing for your appointment

If you suspect that you have Fuchs' dystrophy, make an appointment to see an eye care provider (optometrist or ophthalmologist). In some cases, you might be referred to an ophthalmologist who specializes in corneal disease.

Here's information to help you get ready for your appointment.

What you can do

Make a list of:

  • Your symptoms, and when they began
  • Key personal information, including family history of eye conditions
  • All medications, vitamins or other supplements you take and dose
  • Questions to ask your doctor

Take a family member or a friend along, if possible. You might not want to drive yourself home if your pupils have been dilated for the exam, and your companion can help you remember information you get during your appointment.

For Fuchs' dystrophy, questions to ask your doctor include:

  • What else could cause my symptoms?
  • How will my vision be affected?
  • How rapidly will my condition progress?
  • What tests do I need?
  • What treatments are available, and what do you recommend?
  • I have these other health conditions. How can I manage them together?
  • Do I need to restrict my activities?
  • Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Do your symptoms change throughout the day?
  • Have you noticed changes in your vision?
  • Does your vision seem worse in the morning and improve during the day?

Fuchs' dystrophy care at Mayo Clinic

June 19, 2020
  1. Salmon JF. Cornea. In: Kanski's Clinical Ophthalmology: A Systematic Approach. 9th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed May 1, 2020.
  2. Yanoff M, et al., eds. Diseases of the corneal endothelium. In: Ophthalmology. 5th ed. Elsevier; 2019. https://www.clinicalkey.com. Accessed May 1, 2020.
  3. What is Fuchs' dystrophy? American Academy of Ophthalmology. https://www.aao.org/eye-health/diseases/what-is-fuchs-dystrophy. Accessed May 1, 2020.
  4. Corneal dystrophies. National Eye Institute. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/corneal-conditions/corneal-dystrophies. Accessed May 1, 2020.
  5. Brown AY. Allscripts EPSi. Mayo Clinic. March 12, 2020.
  6. Patel SV (expert opinion). Mayo Clinic. May 2, 2020.
  7. Wieben ED, et al. A common trinucleotide repeat expansion within the transcription factor 4 (tcf4, e2-2) gene predicts Fuchs corneal dystrophy. PLoS One. 2012;doi:10.1371/journal.pone.0049083.
  8. Patel SV, et al. Predicting the prognosis of Fuchs endothelial corneal dystrophy by using Scheimpflug tomography. Ophthalmology 2020; doi:10.1016/j.ophtha.2019.09.033.

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