Fuchs Endothelial Dystrophy:
35-year-old female with blurry vision OU lasting hours in the morning
February 21, 2005
Chief Complaint: 35-year-old female with complaint of intermittent blurry vision OU lasting hours.
History of Present Illness: Patient was sent to neuro-ophthalmology for evaluation of blurry vision OU. The patient complained of decreased vision upon awakening that is not associated with pain. She stated that it's difficult for her to read. The patient also mentioned that her vision seems to clear up as the day progresses.
- Vision: 20/25 OU at distance and near.
- Pupils: 5 mm in dark, 2 mm in light, no RAPD.
- Extraocular Motility: Full motility without pain.
- IOP: 18 mmHg OU.
- Visual Field: Full OU.
- DFE: normal macula, vessels, and periphery OU.
- SLE: notable for a beaten metal appearance of the corneal endothelium OU
Slit beam through cornea. Notice the imperfections (guttae) of the corneal endothelium on the left side of the beam.
Specular microscopy showed low endothelial cell count. Less than 1800 cells/mm2. Most people have more than 2000-3000 cells/mm2 (average of 2400 cells/mm2).
The diagnosis is Fuchs endothelial dystrophy due to endothelial cell loss. Patients have worse vision in the morning because of the eyes being closed during the night causing a buildup of corneal edema (because the endothelium helps keep the cornea dry and clear). During the day, with the eyes open, the cornea becomes a little more dehydrated. Patients can be treated with dehydrating ointments (5% NaCl) or even with a hair dryer in the earlier symptomatic stages prior to PK.
The dark areas on the specular microscopy are regions where the endothelial cells have died (guttae). Because these cells are terminally differentiated cells, they do not divide, so the remaining cells have to stretch to cover more area.
Diagnosis: Fuchs endothelial dystrophy
- Pseudophakic bullous keratopathy
- Chandler's syndrome (this is a unilateral ICE syndrome with a hammered silver appearance of the corneal endothelium)
- Posterior polymorphous dystrophy
- Congenital hereditary endothelial dystrophy (present at birth)
- "Fuchs' Corneal Dystrophy: 7 things you should know" in "All About Vision." Available at http://www.allaboutvision.com/conditions/fuchs-corneal-dystrophy.htm
Suggested citation format: Doan A, Lee AG: Fuchs Endothelial Dystrophy: 35-year-old female with blurry vision OU lasting hours in the morning. February 21, 2005; Available from: http://www.EyeRounds.org/cases/case5.htm.