Eyelids & the Anterior Segment:
                      Case fifteen

The above picture is the corneal histology (PAS staining) of a 75 year-old woman who underwent a corneal graft. She had no previous intraocular surgery.

a. What is the diagnosis?

Fuch's endothelial dystrophy.

The histology shows absent endothelium with thickening of the Descemet's membrane and multiple guttata (seen as nodular thickenings of Descemet's membrane).

b. What is the natural history of this condition?
Fuch's endothelial dystrophy is a common corneal dystrophy which can be inherited in an autosomal dominant manner. The condition is commoner in females than males. The signs and symptoms results from corneal oedema due to reduced endothelium. The disease usually begins centrally and spread peripherally.

Problems usually begins in the middle age with blurred vision especially in the morning. Pain results from ruptured bullae which exposes corneal nerves. With time, the corneal will eventually become vascularized and opacified.

c. What treatment could be used before the operation?

Treatment is aimed at reducing the pain and oedema and this can be achieved with:
  • a soft contact lens is useful in reducing corneal bullae rupture and therefore pain..
  • use of hypertonic solution (5% sodium chloride) is useful in the early stage of corneal oedema to remove the excess stromal fluid.
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