👁 What is Fuchs’ Endothelial Dystrophy?
Fuchs' Endothelial Dystrophy (FED) is a progressive corneal disorder
where corneal endothelial cells fail, leading to corneal swelling (edema) and gradual vision loss.
It usually affects both eyes symmetrically and is more common in middle-aged women (40s–50s).
The earliest sign is the appearance of guttata — droplet-shaped excrescences on Descemet’s membrane.
🔬 Stages of Disease Progression
🟡 Stage 1 – Guttata Only
- Tiny guttae (drop-like lesions) appear on the inner cornea
- No visual symptoms yet
- Termed "endothelial dystrophy" without edema
🟠 Stage 2 – Stromal Edema
- Endothelial cell failure leads to corneal swelling
- Blurry vision upon waking, which improves in the afternoon
- Central corneal thickness increases beyond 700 μm
🔴 Stage 3 – Epithelial Edema
- Formation of epithelial microcysts and bullae (blisters)
- Rupture of bullae causes pain and foreign body sensation
- Vision fluctuates with swelling
⚫ Stage 4 – Scarring and Pannus
- Chronic bullae rupture leads to subepithelial scarring
- Bowman’s layer rupture and fibrovascular pannus formation
- Pain may decrease, but vision loss becomes irreversible
✅ Summary
- From guttata → stromal edema → epithelial bullae → scarring
- Classic symptom: blurry vision in the morning, improves later
- May require corneal transplantation in advanced stages
- Early detection and monitoring are essential
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