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Dry eye syndrome and contact lens intolerance is very common with Fuchs' endothelial corneal dystrophy (FECD). FECD is a genetic corneal dystrophy in which the pumps in the endothelium (inner lining of the cornea) become damaged over time leading to development of guttae (damaged endothelial cells) and ultimately corneal edema (swelling of the cornea). This swelling may take decades to develop but when it does, the increased thickness of the cornea in association with the guttae can lead to decreased vision and the need for surgical correction (surgery is only needed in late stages of FECD). FECD does not typically become symptomatic until after the 5th decade of life and perhaps later than that. Laser vision correction (LASIK or PRK) can be performed on patients with FECD, however, it can potentially worsen the dry eye since one of the main side effects of laser vision correction is worsening of previous dry eye syndrome. Cataracts are also common in FECD and if they are present, this would be another reason not to have laser vision correction. If cataracts are not present and dry eye syndrome is very mild, laser vision correction can definitely be performed with success. PRK has been shown to be safer than LASIK in FECD as the flap created in LASIK is less likely to heal and a higher risk of flap dislodgement is possible with LASIK in FECD. The latter is not an issue with PRK.
Answered by: W. Barry Lee, MD
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