How should bullae associated with Fuchs Endothelial Dystrophy be managed?

How should bullae associated with Fuchs Endothelial Dystrophy be managed?

• A. Treated like recurrent corneal erosions
• B. Observed without treatment
• C. Immediate keratoplasty
• D. Oral NSAIDs

Answer: (A)

Bullae in Fuchs endothelial dystrophy come from edema that weakens the epithelial surface, so the painful problem is the exposed, damaged epithelium rather than the edema itself. The best way to manage these bullae is to treat them like recurrent corneal erosions: protect and hydrate the surface, promote epithelial healing, and minimize further fluid buildup. This includes using hypertonic saline drops or ointment to draw fluid out of the cornea, frequent lubricating drops or ointment to keep the surface moist, and protective measures such as a bandage contact lens if needed. If there is loose or loose-adherent epithelium, gentle debridement can help, and a short course of topical antibiotics may be used to prevent infection after an erosion. While definitive treatment for the underlying endothelial dysfunction (which drives the edema) is possible with endothelial keratoplasty, this is not an emergency choice for bullae alone. Observing without treatment would leave the patient in pain, and systemic pain relievers like oral NSAIDs do not address the epithelial defect or provide surface protection.

Bullae in Fuchs endothelial dystrophy come from edema that weakens the epithelial surface, so the painful problem is the exposed, damaged epithelium rather than the edema itself. The best way to manage these bullae is to treat them like recurrent corneal erosions: protect and hydrate the surface, promote epithelial healing, and minimize further fluid buildup. This includes using hypertonic saline drops or ointment to draw fluid out of the cornea, frequent lubricating drops or ointment to keep the surface moist, and protective measures such as a bandage contact lens if needed. If there is loose or loose-adherent epithelium, gentle debridement can help, and a short course of topical antibiotics may be used to prevent infection after an erosion. While definitive treatment for the underlying endothelial dysfunction (which drives the edema) is possible with endothelial keratoplasty, this is not an emergency choice for bullae alone. Observing without treatment would leave the patient in pain, and systemic pain relievers like oral NSAIDs do not address the epithelial defect or provide surface protection.