Fuchs Dystrophy
Definition
Fuchs’ (pronounced “fooks”) dystrophy affects the cornea, which is the clear structure at the front of the eye. In Fuchs’ dystrophy, cells lining the inner surface of the cornea deteriorate faster than normal. Usually, both eyes are affected.
Alternative names
Fuchs’ endothelial dystrophy; Fuchs’ corneal dystrophy; Fuchs endothelial corneal dystrophy (FECD).
Causes, incidence and risk factors
Fuchs’ dystrophy affects the cornea’s innermost layer called the endothelium. This layer contains active cells that maintain a specific level of hydration, keeping the cornea clear. The number of cells naturally declines over a lifetime, but in Fuchs’ dystrophy, the rate of cell death is accelerated. Areas called guttae appear on the endothelium. Over time, fluid accumulates in the cornea, resulting in a swollen and cloudy cornea.
Fuchs’ dystrophy can be inherited, which means it can be passed down from parents to children. However, the condition may also occur in people without a known family history of the disease.
Fuchs’ dystrophy is more common in women than in men. The condition often does not manifest until middle age. Vision problems do not appear before age 50 in most cases. However, an eye specialist may be able to detect signs of the disease in individuals in their 30s or 40s.
Signs and symptoms
Patients frequently do not have symptoms in the very early stages of Fuchs’ dystrophy. In mild disease, patients may experience foggy or blurry vision that worsens in the morning and improves as the day goes on. As the disease progresses, so does the blurry vision. In advanced stages of Fuchs’, the blurry vision can be severe and may persist throughout the day.
Other symptoms include:
Fluctuating vision throughout the day or from day to day
Scratchy, gritty sensation in the eye
Light sensitivity
Glare and halo effects from bright lights
Decrease in contrast sensitivity
In severe cases, episodes of sharp eye pain may occur from blister formation
When to call your health care provider
Contact your provider if you have:
Eye pain
Eye sensitivity to light
The feeling that something is in your eye when there is nothing there
Vision problems, such as seeing halos or cloudy vision
Worsening vision
Tests
A provider can diagnose Fuchs’ dystrophy during a slit-lamp exam. Other possible tests include:
Pachymetry – Measures the thickness of the cornea. Various contact and contactless devices can be used to make this measurement
Specular microscopy - A microscope projects light in a way that creates an image of the endothelial cells of the cornea
Treatment
Fuchs’ dystrophy is observed or medically treated during the early stages. Treatments include:
Ointments and eye drops for mild symptoms. The medications reduce cornea swelling by removing excess fluid. The improvement is usually temporary.
Using a handheld hair dryer to blow warm air toward the face to help dry up excess fluid. This approach may be most useful if blurriness is worst in the morning.
For painful sores, soft contact lenses or resurfacing procedures may be performed to help reduce eye pain.
In advanced stages where there is significant visual impairment, surgery may be offered.
Partial-thickness corneal transplant, or endothelial keratoplasty, has become the preferred option for people with Fuchs’ dystrophy. In this procedure, the inner layers of the cornea are replaced with healthy layers from a deceased human donor. This technique leads to a faster recovery and fewer complications. Many forms of endothelial keratoplasty are used and may be referred to as DSEK, DSAEK, or DMEK.
Full-thickness corneal transplant, or penetrating keratoplasty, may be necessary in cases where there is scarring of multiple corneal layers. In this procedure, all the layers of the cornea are exchanged. A central round piece of the cornea is removed, and a matching piece from a human donor is sewn in its place.
A newer procedure involves stripping the central portion of the endothelial cell layer to allow peripheral, healthier cells to replace it. This option may not be effective for some patients.
Expectations (prognosis)
Fuchs’ dystrophy can get worse over time, but the rate of progression varies among patients. Most patients develop some degree of blurry vision. In advanced stages, vision can be poor, and the eye may be painful.
Fuchs’ dystrophy can worsen after cataract surgery. A cataract surgeon will evaluate this risk and may modify the technique or timing of your cataract surgery.
Prevention
There are no known prevention measures, but minimizing UV light exposure and smoking may help. Additionally, diabetic patients should work closely with their health care provider to monitor their glucose levels. Avoiding cataract surgery or taking special precautions during cataract surgery may delay the need for a corneal transplant.
Photos and diagrams
References
Castellucci M, Novara C, Casuccio A, et al. Bilateral ultrathin descemet’s stripping automated endothelial keratoplasty vs. bilateral penetrating keratoplasty in Fuchs’ dystrophy: corneal higher-order aberrations, contrast sensitivity and quality of life. Medicina (Kaunas). 2021;57(2):133. PMID: 33546152 pubmed.ncbi.nlm.nih.gov/33546152/.
Folberg R. The eye. In: Kumar V, Abbas AK, Aster JC, eds. Robbins & Cotran Pathologic Basis of Disease. 10th ed. Philadelphia, PA: Elsevier; 2021:chap 29.
Jeang LJ, Margo CE, Espana EM. “Diseases of the corneal endothelium.” Exp Eye Res. 2021 Apr;205:108495. doi: 10.1016/j.exer.2021.108495. Epub 2021 Feb 14. PMID: 33596440; PMCID: PMC8044020.
Patel SV. Towards clinical trials in Fuchs endothelial corneal dystrophy: classification and outcome measures - the Bowman Club Lecture 2019. BMJ Open Ophthalmology. 2019;4(1):e000321. PMID: 31414054 pubmed.ncbi.nlm.nih.gov/31414054/.
Price MO, Price FW Jr. Randomized, double-masked, pilot study of netarsudil 0.02% ophthalmic solution for treatment of corneal edema in Fuchs dystrophy. Am J Ophthalmol. 2021;227:100-105. PMID: 33737034 pubmed.ncbi.nlm.nih.gov/33737034/.
Rosado-Adames N, Afshari NA. Diseases of the corneal endothelium. In: Yanoff M, Duker JS, eds. Ophthalmology. 5th ed. Philadelphia, PA: Elsevier; 2019:chap 4.21.
Salmon JF. Cornea. In: Salmon JF, ed. Kanski’s Clinical Ophthalmology. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 7.
Last reviewed September 26, 2025, by Lauren Jeang, MD, Clinical Assistant Professor, Director of Medical Student Education, UF Department of Ophthalmology.