Fuchs' Dystrophy

Vitamins/supplements   Corneal function   Cornea structure   Corneal edema   Symptoms   Causes   Treatment   Complementary approach   Reviews

Description

The most common cause of cornea swelling (edema) is due to Fuchs' dystrophy, occurring most frequently in people ages 30 to 40. This disease rarely affects vision until people reach ages 50-60. The condition is 2-4 times more common and more severe in women.

Fuchs' dystrophy is a slowly progressing disease that usually affects both eyes. The inner cell layer of the cornea deteriorates, inner layers thicken, and blisters form in other layers. When these tiny blisters or cysts burst, they are extremely painful.

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Corneal Function

The cornea is clear and seems to lack substance, but these layers and groups of cells and proteins are highly organized. Unlike other parts of the body, the cornea does not contain any blood vessels to nourish or protect the tissue against infection. The cornea instead, receives its nourishment from the tears and aqueous humor, a fluid in the anterior portion (front) of the eye that fills the chamber behind the cornea. The cornea must remain transparent to refract light properly and enable clear vision. The presence of even the tiniest blood vessels can interfere with this process. To see well, all layers of the cornea must be free of any cloudy or opaque areas.

The cornea plays several essential roles, both for protecting the eye and for beginning the focusing process.

Corneal Edema

Normally, the cells lining the inside of the cornea help maintain a healthy balance of fluids within the cornea, preventing the cornea from swelling, and helping to keep the cornea clear. But with Fuchs' dystrophy, the endothelial cells slowly die off and probably do not function correctly, resulting in fluid buildup within the cornea (swelling or edema). This causes corneal thickening and blurred vision. The changes to the endothelium and Descemet's membrane lead to corneal swelling, known as edema. This is a condition where the cells of the cornea become less efficient at pumping water out of the stroma, and fluid is retained. With accumulated water, the layers of the cornea swell, distorting vision.

The endothelium, the inner cell layer of the cornea that normally pumps water out of the stroma, deteriorates and thickens as outgrowths called guttae form. Descemet's membrane also thickens and cysts develop in the epithelium. When these cysts (or tiny blisters on the inner side of the corneal surface) burst, they are extremely painful.

Corneal swelling damages vision in two ways: it changes the cornea's normal curvature affecting how light gets focused onto the back of the eye, and it causes sight impairment in the form of a haze. Because there is excess fluid buildup in the cornea tissue, it’s like trying to look through a wet and foggy window.

Structure

The cornea consists of a number of layers that have been identified by scientists. Changes in these layers are indicative of Fuchs’. There is some evidence showing that the likelihood of the onset of Fuchs' can be significantly reduced through lifestyle choices and nutrients. Researchers have determined that free radicals in the cornea may contribute to Fuchs'.

The following layers of tissue have been identified, each with unique functions.

Epithelium layer is filled with thousands of tiny nerve endings that make the cornea extremely sensitive to pain. Its function is to block foreign material, while providing a nutrient-absorbing, oxygen-absorbing surface, and signaling the brain to activate tear production.

Bowman's layer contains collagen fibers that maintain the cornea's shape.

Fuch's Dystrophy

The thin Dua's layer, recently discovered, is the sixth layer in the cornea. It is located at the back of the cornea between the stroma and Descemet’s membrane. This layer is thought to play a vital role in the structure of the tissue that controls the flow of fluid from the eye. New research indicates that this makes an important contribution to the sieve-like meshwork—the trabecular meshwork (TM)—in the periphery of the cornea. A poor functioning trabecular meshwork can lead to glaucoma.

Stroma layer consists of regularly arranged collagen fibers along with sparsely distributed interconnected keratocytes, which are the cells for general repair and maintenance.

Descemet's membrane is a base layer for the growth of endothelium cells.

Endothelium is a single layer of cells that pumps excess water out of the stroma.

Read about the functions of the cornea.

Symptoms

The first symptom is blurry vision that clears during the day. The cornea is a little thicker in the morning and retains fluids that the cornea's pumping action hasn't removed. These evaporate through the day. But as the condition worsens the swelling doesn't improve and begins to reduce vision all through the day. Because of the many different genes that are contributory the condition begins at younger ages than for others.

Causes

Genetics. Fuchs' dystrophy can be inherited. The genetic basis of the disease is complex. Family members can be affected to varying degrees, although sometimes other members are not affected. Several gene malformation types account for early- versus late-onset Fuch's.

Free radicals. Free radicals damage the eyes. They are formed when the ultraviolet and blue light of sunlight passes through the crystalline lens. Free radicals are also natural byproducts of metabolism. These highly reactive chemicals cause oxidation and can destabilize healthy cells in the back of the cornea and the retina as well. Moreover, free radical damage is accelerated by smoking, chronic fatigue, poor diet, chronic stress, and excessive exposure to sunlight and blue light from electronic devices.

Compromised immune system. Conditions that cause chronic inflammation such as autoimmune diseases and diabetes particularly, result in increased production of free radicals.

Conventional Treatment

Patients who have Fuchs' endothelial dystrophy but still have clear corneas, do not typically need treatment. When the cornea starts to change, medical treatment is needed. However, there is no conventional treatment that can actually halt or reverse the course of this disease, just ways to help manage it. If the condition worsens, then the eye doctor may recommend surgery.

In the early stages of Fuchs', doctors will try to reduce corneal swelling with soft contact lenses or ointments targeted to reducing the swelling. They may also instruct a person to use a hair dryer directed across the face at arm's length for 5–10 minutes upon wakening (to dry out the surface of the cornea and tear film). As a dehydrating agent, sodium chloride 5% solution eye drops and/or sodium chloride ointment is often recommended.

Glycerine is used diagnostically, and for some patients it can be therapeutic as well. Glycerine causes rapid dehydration of the cornea and clears vision. Another intervention is to lower the intraocular pressure which helps reduce pressure on the cornea.

If painful sores develop on the cornea, soft contact lenses, or surgery to create flaps over the sores, may help reduce pain.

As visual distortion becomes more severe, a corneal transplant may be recommended as the only alternative for returning impaired vision. The two options currently available are Penetrating Keratoplasty (PK) and Descemet’s Stripping with Endothelial Keratoplasty (DSEK).

Surgery risk factors include bleeding, cataract onset, leakage of fluids from the incision, and damage or, rarely, infection to other parts of the eye. In addition, new vision problems may result as the surgery can cause astigmatism, nearsightedness, and farsightedness, requiring thick lenses on eyeglasses or contact lenses.

The short-term success rate of corneal transplantation is quite good for people with Fuchs' dystrophy. But some studies do suggest that the long-term survival of the donor cornea can be a problem.

Gene therapy may be a future treatment option.

Complementary Approach

Because free radicals in the cornea are considered one of the major contributors of Fuchs' dystrophy, a way to help the body neutralize free radicals is by making sure there are adequate antioxidants in the body to support healthy vision. Antioxidants can be acquired through both diet and targeted supplementation. This is a general approach for helping to prevent and manage most eye and body diseases.

Diet, Nutrition & Lifestyle

  • Homeopathic eyedrops can be helpful to keep the eyes more comfortable
  • Here's a listing of the most important recommendations for Fuchs' Dystrophy. Wearing UV sunglasses, avoiding allergens, stopping smoking, and paying attention to the dietary recommendations are especially important.
  • Favor supplements containing antioxidants since free radicals are a major contributing factor to Fuchs' Dystrophy. Glutathione may be helpful.
  • Gently massage upper and lower lids, a couple of times a day to stimulate the tear glands.

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Studies

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