Pourquoi ma vision est-elle plus floue le matin ?

C'est un signe caractéristique de la dystrophie de Fuchs. La nuit, les paupières fermées, la cornée s'imbibe d'eau (œdème) et la vision est plus trouble au réveil, puis s'éclaircit dans la journée. Avec le temps, ce brouillard peut persister toute la journée.

Qu'est-ce que la cornée guttata ?

Ce sont de petites excroissances (les « guttae ») qui apparaissent sur la face interne de la cornée quand l'endothélium se raréfie. Elles sont le signe précoce de la dystrophie de Fuchs et se voient à l'examen à la lampe à fente.

Quel est le traitement ?

Aux stades débutants, des collyres peuvent réduire l'œdème matinal. Quand la vision est gênée, le traitement de référence est la greffe endothéliale sélective (DMEK), qui remplace seulement la couche malade et offre une récupération rapide.

Fuchs dystrophy: cloudy cornea and endothelial graft

Name: Dystrophie de Fuchs
Creator: Pr Eric E. Gabison

Fuchs dystrophy is a common disease of the endothelium, the inner layer of the cornea responsible for keeping it transparent. When this endothelium becomes depleted, the cornea takes up water and vision becomes blurred, especially in the morning. Today a highly selective graft — DMEK — allows rapid recovery.

Cornea guttataCorneal oedemaDMEKDSAEK

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How does the endothelium work?

The endothelium lines the inner surface of the cornea. It acts as a “pump” that continuously removes water from the cornea to keep it clear. Its cells do not renew themselves: as they become depleted, the pump becomes insufficient and the cornea swells (oedema), blurring vision.

What are the signs?

Blurrier vision on waking that improves during the day — a highly suggestive sign.
Visual haze and halos, with light sensitivity.
At a more advanced stage, persistent cloudy vision, sometimes with discomfort.
On examination, the presence of guttae (cornea guttata), the characteristic early sign.

How is it diagnosed?

Diagnosis is made at the slit lamp (visualising guttae and oedema) and confirmed by tests measuring corneal thickness and counting endothelial cells (specular microscopy, OCT). This work-up establishes the stage and guides treatment decisions, particularly before any cataract surgery.

Treatments

In the early stages

When symptoms are limited to the morning, eye drops (hypertonic saline solutions) help reduce oedema and clear vision early in the day.

DMEK endothelial graft

When vision is genuinely impaired, the reference treatment is DMEK: only the diseased Descemet membrane and endothelium are replaced with healthy tissue, leaving the rest of the cornea untouched. This highly selective approach offers rapid visual recovery and a low risk of rejection. DSAEK is a slightly thicker alternative, useful in certain situations. For a full explanation of the techniques, see the corneal graft page.

Fuchs and cataract: planning ahead

Fuchs dystrophy and cataract often coexist with age. Detecting the disease before cataract surgery makes it possible to adapt the strategy (sometimes combining graft and cataract surgery) and to protect the endothelium as far as possible.

Before you decide

All questions →

Blurred vision in the morning, cornea guttata?

An endothelial work-up establishes the stage and the appropriate options.

Book an appointment

Are you a healthcare professional? To go further: the expert course “Fuchs dystrophy & cornea guttata” (pathophysiology, genetics, diagnosis, DSO/ROCK, DMEK), and the chapter on endothelial grafts.

This page is for general information only and does not replace a medical consultation. Stage and treatment are individualised after a full examination. Pr Eric E. Gabison — corneal and ocular surface surgery, Rothschild Foundation Hospital, Paris.