Foggy or Blurred Vision

The cornea is the clear window on the front of the eye. It bends incoming light rather dramatically to focus an image on the retina at the back of the eye enabling us to see. The cornea is constructed of overlapping layers of tight packed and orderly arranged collagen fibrils. Finally, there is an ionic pumping mechanism that maintains the delicate balance of fluid content that yields clear corneal tissue.

Endothelial Dystrophy (Fuchs) and Disease
The inside limiting membrane of the cornea is the endothelium. The endothelium is in essence a pump which controls to flow of fluid in and out of the cornea. Fuchs dystrophy is a slow progressive hereditary disorder. In Fuchs endothelial dystrophy, guttae lesions form on the inside layer of the endothelium forcing endothelial cells to slowly drop off the back of the cornea. Remaining cells change shape and spread to replace those missing. Fewer cells reduces the efficiency of the pump resulting increased fluid uptake, edema and corneal clouding.

As this excessive fluid retention spreads to the middle layer (stroma) and outer layer (epthielium) of the cornea the patient experiences halos around lights and glare as the vision becomes increasingly blurred. A painful blister can occur on the corneal epithelium.

Some patients find relief from this pain with the use of a soft contact lens. There are no other treatment options. Once the vision has deteriorated significantly a penetrating keratoplasty (corneal graft) is recommended.

Traditional vision corrections, eyeglasses and contact lenses, offer little improvement to vision. After surgical intervention most patients find the greatest improvement in vision associated with the use of rigid gas permeable lenses. Fitting a rigid lens on a cornea recovering from a transplant requires great skill and experience to protect the eye and improve the vision.

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