Fuchs’ Dystrophy

This is a condition where the cornea gets too wet and cloudy. The cornea (the clear window that makes up the front of the eye) is clear because it is relatively dehydrated compared to the rest of the eyeball.  This may seem counterintuitive at first. After all, isn’t the eye covered by tears on the outside and the inside of the eye filled with aqueous fluid? How can the cornea be dry?  The cornea is dry because the innermost layer of the cornea has tiny cells that act like “bilge pumps,” sucking water out of the cornea and continuously pumping that water back inside the eye.  People with Fuchs’ have less of these pump cells than normal and are at risk for their cornea getting too boggy and cloudy.  This is especially true after eye surgery, as surgical trauma tends to shock a certain number of these pump cells so that they stop working.  If the cornea gets wet enough to affect vision, then a corneal transplant may be needed. DSEK surgery is a newer type of transplant where only the inner layers of the cornea (including the pump layer) are replaced. Early treatments include hyperosmotic drops like Muro 128 and FreshKote. Glaucoma drops can help to lower the internal ocular pressure so that the pump cells don’t have to work so hard.