Fuchs' endothelial corneal dystrophy (FECD) is a slowly progressing corneal edema that usually affects both eyes.

It is slightly more common in women than in men, and generally begins to affect people’s vision in their 50s and 60s. FECD can be a hereditary condition.

FECD affects the innermost layer of the cornea, called the corneal endothelium. This cell layer consists of thousands of tiny cells that pump water out of the cornea and into the eye.

In FECD patients, the corneal endothelial cells die and do not replace themselves. As a result, bumps, called guttae, begin to form on the back of the cornea. This causes the cornea to swell and distort vision resulting in pain and severe visual impairment.

This swelling damages vision by changing the cornea's normal curvature and causing a sight-impairing haze to appear in the tissue. Epithelial swelling will also produce tiny blisters on the corneal surface. When these blisters burst, they are extremely painful.

Because the cornea is the "window of the eye" and focuses light entering the eye, patients with more advanced FECD find it harder to handle light. People with FECD often find that things look blurry, with a "ghost-like" blur. Many people with FECD report feeling blinded by car headlights at night and have difficulty identifying people when the light source is behind the person or object they are viewing. 

Warning Signs of FECD

A common warning symptom of FECD is waking up with blurred vision that gradually clears during the course of a day. This occurs because the cornea is normally thicker in the morning since it retains fluids during sleep that later evaporate while we are awake.

As FECD worsens, the swelling will remain constant and reduce vision throughout the course of a day.

Treatment of FECD

When treating the disease, doctors will try first to reduce the corneal edema (swelling) with drops, ointments, or soft contact lenses.

When the disease interferes with daily activities, a person may need to consider having a corneal transplant to restore sight.

Descement’s stripping endothelial keratoplasty (DSEK) is one of the modern corneal transplant procedures offered to treat FECD. In DSEK, only the diseased endothelial cells (and its backing membrane, Descemet's membrane) are removed. It is then replaced with healthy endothelial tissue from a donor cornea. These healthy endothelial cells help to clear the diseased cornea to which they are transplanted.

The short-term success rate of corneal transplantation is quite good for people with FECD, but a lifetime risk of corneal graft rejection and failure remains.

To learn about a study Duke Eye Center is conducting in collaboration with the National Eye Institute and the Wilmer Eye Institute, visit Fuchs' Endothelial Corneal Dystrophy Research.

Learn more about cornea and external eye diseases:

• Cornea and External Eye Disease Glossary
• Cornea Transplantation
• Cataracts: Restoring Your Vision

For more information about Fuchs' endothelial corneal dystrophy, contact the Duke Eye Center to make an appointment near you in Raleigh, Durham, Cary, and many areas of North Carolina.