Dystrophies by layer
Dystrophies are classified by the corneal layer they affect, which also predicts their symptoms:
- Epithelial and basement membrane: map-dot-fingerprint (epithelial basement membrane) dystrophy is common and causes recurrent corneal erosions and fluctuating vision; treated with lubricants, hypertonic drops, bandage lenses or a surface polishing procedure
- Bowman's layer: Reis-Bücklers and Thiel-Behnke dystrophies cause erosions and surface scarring from childhood; treated with surface laser (PTK) when vision is affected
- Stromal: granular, lattice and macular dystrophies deposit opaque material in the stroma, gradually blurring vision; managed with PTK for superficial deposits and lamellar transplantation for deep ones
- Endothelial: Fuchs dystrophy, the most important, in which the pumping cells of the inner layer fail and the cornea swells; managed with hypertonic drops early and with endothelial transplantation (DMEK or DSAEK) when vision declines
Symptoms
Epithelial dystrophies cause sharp pain on waking, grittiness and fluctuating vision as the surface loosens and heals. Stromal dystrophies cause slowly increasing haze and glare. Fuchs dystrophy causes blurred vision that is worst in the morning and clears through the day, with glare and halos, progressing over years. Many dystrophies are found incidentally at a routine eye exam before they cause symptoms.
Diagnosis
The slit lamp appearance of each dystrophy is characteristic. Specular microscopy counts and images the endothelial cells in Fuchs dystrophy and tracks them over time. Pachymetry measures corneal thickness, which rises as an endothelial dystrophy progresses. Anterior segment OCT shows the depth of stromal deposits. Family history is asked about, because relatives may benefit from screening.
Why dystrophies matter for other eye surgery
A dystrophy changes the plan for LASIK and cataract surgery. Basement membrane dystrophy is a reason to choose PRK over LASIK, since a flap can loosen the surface. Fuchs dystrophy calls for gentle cataract surgery with techniques that protect the endothelium, and sometimes for endothelial transplantation, which the cornea specialist discusses when appropriate. The corneal assessment before any surgery here screens for them.
Is this right for your eyes?
Nothing on this page is a diagnosis. Whether this is what is affecting your vision is decided by a full examination at one of our 4 offices: Pasadena, Huntington Beach, Woodland Hills and Beverly Hills.
About this content: This page was written with the assistance of AI tools and reviewed for medical accuracy by Dr. Bavand Youssefzadeh, DO. It is general information, not medical advice, and does not replace an eye examination. Individual results vary. Read our medical disclaimer.
