Corneal Dystrophies

What are corneal dystrophies?

Corneal dystrophies are a group of conditions that cause abnormal changes within one or more layers of the cornea. Many are inherited and affect both eyes, although the age at which symptoms appear and the effect on vision vary widely between different dystrophies.

Some people have no symptoms and only discover a corneal dystrophy during a routine eye examination. Others may develop recurrent eye pain, glare, blurred vision or a gradual reduction in corneal clarity.

What types of corneal dystrophy are there?

The cornea is made up of several layers, and dystrophies can be grouped according to the layer they mainly affect. Examples include epithelial basement membrane dystrophy, granular and lattice dystrophies, and endothelial conditions such as Fuchs’ dystrophy. The exact diagnosis is important because treatment differs between types.

Symptoms of corneal dystrophies

• Blurred, hazy or fluctuating vision
• Glare or halos around lights
• Recurrent episodes of eye pain
• A gritty or foreign-body sensation
• Light sensitivity
• Reduced corneal clarity
• No symptoms at all in mild cases

How are corneal dystrophies diagnosed?

Your ophthalmologist will examine the cornea with a slit lamp and may use corneal imaging, photography, optical coherence tomography or other tests to identify the layer involved. Your family and medical history can also provide useful information. In selected cases, genetic testing may be considered.

Treatment options

Treatment depends on the type of dystrophy, where it is located in the cornea and whether it is affecting vision or causing recurrent erosions. Some people only need observation and regular review.

• Lubricating eye drops or ointments for surface discomfort
• Hypertonic saline in selected conditions with corneal swelling
• Bandage or specialised contact lenses for selected surface problems
• Phototherapeutic keratectomy (PTK) for some superficial corneal deposits or recurrent erosions
• Partial- or full-thickness corneal transplantation when deeper disease significantly affects corneal clarity or vision

Are corneal dystrophies inherited?

Many corneal dystrophies have a genetic basis, but inheritance patterns vary. Having a family member with a corneal dystrophy does not always mean you will develop the same symptoms or severity. Your ophthalmologist can advise whether family screening or genetic counselling may be useful.