A 35-year-old man presents with recurrent attacks of unilateral reduced vision, seeing halos, and corneal edema that clears by afternoon. Slit-lamp examination shows Descemet membrane folds and stromal edema in the morning. The most likely diagnosis is:

• A Fuchs endothelial dystrophy ✓
• B Lattice corneal dystrophy
• C Granular corneal dystrophy
• D Macular corneal dystrophy

Explanation

Fuchs endothelial dystrophy is characterised by progressive loss of corneal endothelial cells leading to guttae on Descemet membrane, stromal oedema that is worst in the morning (due to nocturnal reduced evaporation) and clears partially during the day. It is bilateral, more common in women, and may ultimately require penetrating keratoplasty or DSAEK. The morning blur and corneal guttae are hallmark features.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.