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Epithelial and Stromal Dystrophies

Epithelial and stromal dystrophies are inherited corneal dystrophies that can sometimes be painful, impair vision, and erode the cornea. Even if no symptoms are noticed, the cornea may be weakened.

Epithelial Dystrophies
Epithelial dystrophies affect the epithelial layer of the cornea. This is the outermost layer and protects the eye. It is very sensitive because it is full of nerve endings.

Epithelial Basement Membrane Dystrophy
(map-dot-fingerprint dystrophy)
This is the most common epithelial dystrophy. Most people do not experience symptoms, but some have painful foreign body sensations and a few have temporary blurry vision after the age of 30. An eye patch or a bandage contact lens are sometimes used to treat pain and allow the cornea to heal.

Reis-Bücklers’ Dystrophy
Symptoms of Reis-Bücklers’ Dystrophy tend to appear in childhood and affect both eyes equally. The corneal surface may become hazy and irregular. Symptoms include light sensitivity, foreign body sensation, and vision impairment. In some cases a corneal transplant is necessary, but the condition can come back quickly, destroying the new cornea as well.

Meesmann’s Dystrophy
The primary symptom of Meesmann’s Dystrophy is foreign body sensation caused by epithelial erosion. It usually affects both eyes equally, and in most cases does not cause vision loss. Symptoms may appear as early as one to two years of age, or may not appear until middle age. This dystrophy is very rare.

Stromal Dystrophies
The stroma is the second (middle) corneal layer and makes up about 90% of the cornea’s thickness. It is 75% water and also contains collagen, which makes the cornea strong and flexible. This is the layer where the LASIK laser reshapes the cornea for clearer vision. Corneal dystrophies are inherited opacities and are subdivided according to where on the cornea they develop. A corneal transplant is usually required.

Granular Dystrophy
Granular dystrophy normally occurs before the age of 20, but does not become noticeable until later in life. It starts out as tiny grayish dots, visible only through a microscope. Gradually the dots become larger and are visible to the naked eye. Some people experience vision loss after age 50, and may also experience light sensitivity and foreign body sensation. In a few cases a corneal transplant is necessary, but the dystrophy may return within five years.

Macular Dystrophy
Macular dystrophy can cause severe vision loss in early adulthood. It begins with small, irregular cloudy areas on the cornea, which grow and cover the eye, eventually causing vision loss. It can cause severe light sensitivity. A cornea transplant is often required. The dystrophy may return, but it usually takes at least 20 years to do so.

Lattice Dystrophy
Lattice dystrophy can appear at any time in life, but normally appears in children between two and seven years old. Abnormal protein fibers accumulate and make lines in the cornea. Over time they get darker and converge. The cornea becomes cloudy impairs vision. Lattice dystrophy can cause very painful recurrent epithelial erosion. For some a corneal transplant may be necessary. After a transplant, the dystrophy may come back in five to ten years.

Corneal dystrophies range in severity from being unnoticeable to causing blindness and severe pain. A corneal transplant is often the only effective treatment, and with some types of dystrophies the results may not be long-lasting. Because the cornea is weakened, and sometimes in a constantly changing state, LASIK is usually not recommended, but there are sometimes exceptions or alternatives.

If you are considering LASIK and have corneal dystrophy or a family history of corneal dystrophy, ask your ophthalmologist about the risks and alternatives today. Please use the links below to find an experienced eye surgeon in your area.

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