DEAR MAYO CLINIC:

Do I need treatment for Fuchs' dystrophy if it's not bothering me very much? My vision has gradually gotten worse but it's not too bothersome. If I do need treatment, what are my options?

ANSWER:

Fuchs' dystrophy is an uncommon, progressive condition that causes fluid buildup within the eye's cornea. The goal of treatment for Fuchs' dystrophy is to control the symptoms. So if the symptoms of Fuchs' dystrophy don't bother you, treatment isn't necessary. If the condition interferes with your vision or causes significant discomfort, however, a range of treatment options is available -- from eyedrops in mild cases to surgery in more severe cases.

The cornea is the transparent surface that covers the front of the eye. Fuchs' dystrophy affects the inner lining of cells (endothelium) in the cornea. Normally, the endothelium pumps excess fluid out of the cornea. This helps the cornea stay thin and clear. But with Fuchs' dystrophy, those endothelial cells slowly deteriorate and die. As a result, fluid accumulates within the cornea. This can cause swelling within the cornea, cloudy or blurry vision, and eye pain. Typically, Fuchs' dystrophy affects both eyes.

Although the exact cause of Fuchs' dystrophy isn't known, in some people it may be hereditary. The inheritance pattern of Fuchs' dystrophy is complex. The disease clusters within families, but no specific hereditary pattern can be identified. Even when inherited, the severity of signs and symptoms may vary considerably between family members. For example, a parent with a severe case of Fuchs' dystrophy and numerous vision problems could have a child who has a mild case and few symptoms.

Symptoms of Fuchs' dystrophy may fluctuate. For instance, some people who have Fuchs' dystrophy notice more vision blurriness in the morning, but as the day goes on their vision seems to clear on its own without treatment. If this is the case in your situation and the symptoms of Fuchs' dystrophy don't noticeably hamper your vision, you don't need to pursue treatment.

If you begin to notice symptoms that interfere with or limit your normal daily activities, talk to your ophthalmologist about possible treatment options. In some cases, eyedrops or ointments containing sodium chloride may be all that's needed to remove extra fluid from the cornea and relieve symptoms. You may also be able to decrease excess corneal fluid by holding a hair dryer on a low setting at arm's length and blowing warm air across your face two or three times a day. The warm air can help the extra fluid to evaporate, easing mild symptoms. Make sure the air isn't hot, as that could damage your eyes.

When Fuchs' dystrophy significantly inhibits vision or causes considerable discomfort, surgery may be necessary. Surgical treatment of Fuchs' dystrophy can involve a full cornea transplant (keratoplasty), in which all sections of the damaged cornea are replaced with a donor cornea. More commonly, surgery may include replacement of the diseased inner lining of the cornea only. In most cases, surgery for Fuchs' dystrophy considerably improves the quality of vision.

Amir Khan, M.D., Ophthalmology, Mayo Clinic, Rochester, Minn.

Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care.

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