Eye condition

Fuchs' Endothelial Dystrophy

A progressive condition affecting the cornea's inner (endothelial) cells that keep it clear — leading to swelling, cloudy vision and glare, often worse on waking.

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What is Fuchs' endothelial dystrophy?

Fuchs' endothelial dystrophy is a progressive condition that affects the inner layer of the cornea, called the endothelium. These cells normally pump excess fluid out of the cornea to keep it clear. In Fuchs' dystrophy, the number and function of endothelial cells gradually decline, allowing fluid to build up and the cornea to become swollen and cloudy.

Fuchs’ dystrophy usually affects both eyes and often develops slowly. Many people do not notice symptoms until later adulthood.

What are the symptoms of Fuchs' dystrophy?

Blurred or cloudy vision, often worse on waking
Vision that improves later in the day in earlier stages
Glare and halos around lights
Difficulty with night driving
Reduced contrast or clarity
Eye discomfort or a gritty sensation
Pain from surface blisters in more advanced disease

Why is vision often worse in the morning?

While your eyes are closed during sleep, less fluid evaporates from the corneal surface. If the endothelial pump cells are not working efficiently, more fluid can remain in the cornea overnight. This can make vision foggier on waking. As the condition progresses, the blur may last longer or remain throughout the day.

How is Fuchs' dystrophy diagnosed?

Diagnosis is made with a detailed eye examination. Your ophthalmologist may assess the appearance of the endothelial layer, measure corneal thickness and use specialised imaging or endothelial cell assessment. Cataracts are also common in the same age group, so it is important to determine how much of the visual change is coming from the cornea and how much is from the lens.

Treatment options

Early or mild disease

If symptoms are mild, monitoring may be all that is required. Hypertonic saline drops or ointment may be used in some patients to reduce corneal swelling temporarily, although these treatments do not replace lost endothelial cells.

Endothelial keratoplasty

When corneal swelling causes persistent visual problems, your ophthalmologist may recommend endothelial keratoplasty. Procedures such as DMEK replace the unhealthy inner corneal layer with healthy donor endothelial tissue while leaving most of your own cornea in place. The most suitable approach depends on your cornea, previous eye surgery and other eye conditions.

Fuchs’ dystrophy and cataract surgery

If you also have a cataract, your surgeon will assess whether cataract surgery can be performed alone or whether corneal treatment should be combined with, or planned around, cataract surgery. This decision depends on the health of the endothelial cells and the degree of corneal swelling.

FAQ

Common questions.

Fuchs’ dystrophy can run in families and has a genetic component, although the pattern is not the same in every family. A family history is useful information to share with your ophthalmologist.

No. Eye drops may reduce symptoms or corneal swelling temporarily in selected patients, but they do not replace endothelial cells. Surgery may be considered when vision is significantly affected.

Often yes, but the cornea needs careful assessment first. In some eyes cataract surgery alone is appropriate; in others, endothelial keratoplasty may be performed at the same time or separately.

Descemet membrane endothelial keratoplasty (DMEK) is a partial-thickness corneal transplant that replaces the diseased inner corneal layer with healthy donor endothelial tissue.

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