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Corneal Diseases

Fuchs Dystrophy Bullous Keratopathy Keratoconus Pterygium Corneal Ulcer

What Is Fuchs Dystrophy?

The front of the eye is covered by a clear portion called the cornea which functions as the “windshield” of the eye. The cornea needs to stay clear in order for the light to travel through it and allow us to see. The inner layer of the cornea is composed of endothelial cells which function as “water pumps” to remove excess fluid and keep the cornea clear and transparent. We lose some of those cells over time, but most people have enough cells left over throughout their lifetime to not cause a problem.

People with Fuchs dystrophy lose those cells faster than an average person. This leads to blurry vision as the cornea gets progressively more swollen over time.

Causes

  • Most cases are sporadic (no identifiable cause)
  • Genetic (Fuchs dystrophy can run in families)
  • Previous eye surgery can exacerbate Fuchs dystrophy

Symptoms

  • Blurry vision, particularly early in the day
  • Glare
  • Halos
  • Perception of looking through a “foggy window”
  • Eye pain

Management

People with no symptoms do not require treatment. As the vision gets more blurry from the swelling, Muro 128 (Sodium Chloride 4%) eye drops or ointment can be used to help absorb the fluid from the cornea from the front side. As the swelling progresses, the drops will become insufficient and a partial cornea transplant (DSAEK or DMEK) is needed to replace those cells.

Bullous Keratopathy

What Is Bullous Keratopathy?

The front of the eye is covered by a clear portion called the cornea which functions as the “windshield” of the eye. The cornea needs to stay clear in order for the light to travel through it and allow us to see. The inner layer of the cornea is composed of endothelial cells which function as “water pumps” to remove excess fluid and keep the cornea clear and transparent. We lose some of those cells over time, but most people have enough cells left over throughout their lifetime to not cause a problem.

People with Bullous Keratopathy are predisposed to lose cells faster than an average person after having eye surgery. This leads to blurry vision as the cornea gets progressively more swollen over time. In many cases, it is challenging to predict who will develop Bullous Keratopathy after surgery.

Causes

  • Previous eye surgery
  • Previous eye conditions that have weakened the endothelial cells (Uveitis, Infection, Fuchs Dystrophy)
  • Genetic factors

Symptoms

  • Blurry vision, particularly early in the day
  • Glare
  • Halos
  • Perception of looking through a “foggy window”
  • Eye pain

Management

People with no symptoms do not require treatment. As the vision gets more blurry from the swelling, Muro 128 (Sodium Chloride 4%) eye drops or ointment can be used to help absorb the fluid from the cornea from the front side. As the swelling progresses, the drops will become insufficient and a partial cornea transplant (DSAEK or DMEK) is needed to replace those cells.

Keratoconus

What Is Keratoconus?

The front of the eye is covered by a clear portion called the cornea which functions as the “windshield” of the eye. The cornea needs to stay clear and smooth in order for the light to travel through it and allow us to see. The structural integrity of the cornea is provided by evenly spaced layers of collagen. People with keratoconus have a weakening of the collagen which leads to permanent bending of the cornea into an irregular shape (like a mirror becoming a “funhouse mirror”). This leads to frequent changes in glasses prescription and eventually a need for contact lenses to see better. Over time, the bending of the cornea causes scar formation which permanently clouds the vision. Some people may develop “corneal hydrops” which is an acute break in the cornea which causes immediate pain and blurry vision for several weeks.

Causes

  • Eye rubbing
  • Eye Allergies
  • Genetic factors
  • Associated with previous refractive surgery, Down Syndrome, Marfan Syndrome, and other collagen disorders.

Symptoms

  • Blurry vision
  • Distorted vision
  • Eye pain

Management

People with no symptoms do not require treatment, but it is crucial to never rub the eye and treat any eye allergies. Early cases can be corrected with glasses or contact lenses. Young people who experience progression can benefit from corneal Cross-linking, a procedure where ultraviolet light is used to bind corneal collagen together to improve structural integrity. Once Keratoconus progresses past the point of correction of glasses and contact lenses, a full-thickness corneal transplant can be performed to replace the cornea.

Pterygium

What Is a Pterygium?

The front of the eye is covered by a clear portion called the cornea which functions as the “windshield” of the eye. The cornea needs to stay clear and smooth in order for the light to travel through it and allow us to see. The white part of the eye is covered by a layer called the conjunctiva. In some people, the conjunctiva can grow over cornea, due to chronic eye irritation, causing a pterygium. This can lead to eye irritation, eye redness, and blurry vision.

Causes

  • Exposure to wind and UV light
  • Genetic factors
  • Eye irritation

Symptoms

  • Blurry vision
  • Distorted vision
  • Eye pain
  • Eye redness

Management

People with no symptoms do not require treatment but it is crucial to reduce eye irritation and exposure to UV light. Early cases can be corrected with glasses and eye irritation. Once the pterygium becomes symptomatic, it can be surgically removed to improve the symptoms.

Corneal Ulcer

What Is a Corneal Ulcer?

The front of the eye is covered by a clear portion called the cornea which functions as the “windshield” of the eye. The cornea needs to stay clear and smooth in order for the light to travel through it and allow us to see. In some people, this tissue can become infected causing pain and a severe threat to vision. The infection can be caused by bacteria, fungi, viruses, or parasites.

Causes

  • Contact lens wear
  • Sleeping in contact lenses
  • Eye trauma
  • Previous eye conditions compromising the eye surface

Symptoms

  • Eye pain
  • Foreign body sensation
  • Eye redness
  • Blurry vision

Management

People with an eye infection require urgent evaluation and treatment. Small infections can be treated with medications, while more serious infections usually require culturing the microbe to help hone down the treatment. Once the infection is resolved, it leaves a residual scar which could be treated with glasses, contact lenses, or a corneal transplant.

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