On specular examination of a 62-year-old woman with blurred vision that is worst on waking and clears through the day, you see small dark excrescences scattered over the posterior corneal surface resembling drops of dew, with increasing stromal edema. Endothelial cell count is markedly reduced. What is the underlying pathology?

• A Progressive loss of corneal endothelial cells with guttae on Descemet membrane ✓
• B Accumulation of glycosaminoglycans in the stroma
• C Amyloid deposition between Bowman layer and stroma
• D Breaks in Descemet membrane with Descemetocele formation

Explanation

Cornea guttata with progressive endothelial failure defines Fuchs endothelial dystrophy. Loss of the endothelial pump causes fluid to collect in the stroma overnight, giving morning blurring that improves during the day as evaporation thins the cornea. Glycosaminoglycan stromal accumulation describes macular dystrophy, amyloid between Bowman layer and stroma describes lattice dystrophy, and Descemet breaks occur in birth trauma or keratoconus acute hydrops, none of which produce guttae.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.