Fuchs' endothelial dystrophy is characterised by primary progressive endothelial cell loss. In the early stage, slit-lamp examination shows:

• A Corneal vascularisation at the limbus
• B Epithelial bullae on the anterior surface
• C A horizontal white band across the corneal stroma (band keratopathy)
• D Guttata (excrescences of Descemet's membrane), best seen by retroillumination or specular reflection ✓

Explanation

Fuchs' endothelial dystrophy begins with formation of corneal guttata—tiny, wart-like excrescences of Descemet's membrane produced by abnormal collagen secretion from dysfunctional endothelial cells. Early guttata appear centrally as a 'beaten metal' or 'orange peel' appearance on specular reflection. As endothelial cells continue to fail, the cornea loses its ability to maintain dehydration (pump-leak balance), leading to progressive stromal and then epithelial edema (bullous keratopathy). Corneal transplantation—now preferably DMEK or DSAEK—is required in advanced disease.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.