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Oculoplastics

Cornea & External Diseases

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dystrophies
Slitlamp view shows moderate stromal edema and metal-beaten appearance of the Descemet's membrane.
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Fuchs' Dystrophy

  • Occasionally it is inherited as an autosomal dominant trait.
  • Affects women more frequently and more severely than men.
  • Clinical features:
    • Symptoms:
      • Foreign body sensation, pain, tearing, photophobia
      • Significant blurring of vision when these blisters rupture
    • Signs:
      • Asymmetrical bilateral endothelial dystrophy that often presents in the fifth or sixth decade, but can be seen clinically in younger patients
      • Multiple central corneal guttata (excresences of Descemet's membrane) associated with pigment dusting on the endothelium
      • With specular reflection, they appear as black holes in the endothelial mosaic
    • Advanced stage:
      • Decreased endothelial cell density
      • Compromised endothelial cell pump function results in corneal edema
      • Bullous keratopahy usually developed in the decompensated corneal
      • As the corneal edema progresses and becomes chronic, diffuse subepithelial scarring may form, separating the epithelium from stroma
      • Corneal sensation is usually diminished
  • Treatment:
    • Hypertonic agents such as sodium chloride 5% drops or ointment to treat early epithelial edema.
    • Topical or oral intraocular pressure lowering medications.
    • Lubricant eye drops or soft bandage contact lens may relieve discomfort by covering the exposed corneal nerve endings.
    • Penetrating keratoplasty has a high success rate when performed in advanced case where visual rehabilitation is desired.


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