Corneal Dystrophies

About Corneal Dystrophies

A corneal dystrophy is a condition in which one or more parts of the cornea lose their normal clarity because of a build-up of cloudy material. There are more than 20 corneal dystrophies that affect all parts of the cornea. Many of them are inherited and not the result of other health issues or lifestyle factors. Some dystrophies can cause severe pain without leading to permanent vision loss.

Some types of corneal dystrophies we treat include:

• Keratoconus – this is the most common corneal dystrophy in the U.S and is most prevalent in teenagers and adults in their 20s. It happens when the middle of the cornea thins and gradually bulges outward, forming a cone shape. This bulging changes the how the cornea refracts (bends) light and can cause refractive errors such as nearsightedness and astigmatism. It can also cause swelling and scarring of the cornea, which can harmvision. Keratoconus usually affects both eyes.
• Fuchs' Dystrophy – this is a slowly progressing condition and causes the cornea to swell painfully and distorts vision. As the disease worsens, blurred vision will stay constant throughout the day.
• Granular Dystrophy – this causes "crumb-shaped" lesions to form on the inside of the eye. Over time, these lesions can grow and affect vision. In some people, the condition also causes eye pain or discomfort.
• Lattice Dystrophy – this causes abnormal protein fibers (called amyloid deposits) to collect in the part of the eye called the stroma. Over time, these groups of fibers converge and take up more of the stroma. This causes cloudiness in the cornea and can also harm vision.
• Map-Dot-Fingerprint Dystrophy – this happens when part of the epithelium does not develop normally, and epithelial cells cannot properly adhere to it. This causes the erosion of the epithelium and leads to changes in the curve of the cornea, causing periodic blurred vision.

Treatments We Offer

At first, vision problems from keratoconus can be treated with eyeglasses. But if the astigmatism worsens, specially fitted contact lenses might be needed to reduce distortion and provide better vision. Another treatment, called corneal collagen crosslinking has recently been shown to stop the progression of keratoconus. In about 10 to 20 percent of people with this condition, the cornea will become too scarred or will not tolerate a contact lens. If either of these problems happen, a corneal transplant might be necessary to treat the keratoconus.

To treat Fuchs’ dystrophy disease, doctors will try first to lower the swelling with saline eyedrops, ointments, or soft contact lenses. Once the disease interferes with daily activities, the patient might need to have a corneal transplant.

With Lattice dystrophy some people will have scarring under the epithelium causing a haze on the cornea that can harm vision. In this case, a corneal transplant might be needed. While transplant is a good option for people with this condition, the condition might happen in the donor cornea in as little as three years. If this happens, early treatment with the excimer laser can help. This treatment is called phototherapeutic keratectomy (PTK). PTK can remove the diseased layers of the cornea.

Map-dot-fingerprint dystrophy treatment is focused on controlling the pain from epithelial erosion. Columbia ophthalmologists might recommend using a patch over the eye to keep it still or give lubricating eye drops and ointments. With treatment, these erosions usually heal within three days, although periodic flashes of pain might occur for several weeks afterward. Other treatments include anterior corneal punctures to allow cells to adhere to the epithelium better, corneal scraping to remove damaged areas of the cornea and allow healthy epithelial tissue to grow, and excimer laser treatment (PTK) to remove areas on the surface of the cornea.

Why Choose Columbia?

Although corneal dystrophies may not be common, experienced Columbia ophthalmologists can accurately diagnose and treat all types of corneal dystrophy conditions with compassionate, advanced, and integrative care.