Question:medium
A patient presents with guttate lesions in one eye and bullous keratopathy in the other. What is the most likely diagnosis?
A patient presents with guttate lesions in one eye and bullous keratopathy in the other. What is the most likely diagnosis?
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Corneal guttata with bullous keratopathy = Fuchs' endothelial dystrophy.
Updated On: May 14, 2026
- Fuchs' endothelial dystrophy
- Viral corneal ulcer
- Interstitial keratitis
- Keratoconjunctivitis
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The Correct Option is A
Solution and Explanation
Step 1: Understanding the Question:
The combination of corneal "guttae" (early stage) and "bullous keratopathy" (late stage) describes the natural history of a specific posterior corneal dystrophy.
Step 2: Detailed Explanation:
Fuchs' Dystrophy: This is a progressive, inherited disease of the corneal endothelium. It is usually bilateral but can be asymmetric.
Pathophysiology: The endothelial cells fail to pump water out of the cornea properly. The hallmark early sign is "guttae"—beaten metal-like bumps on the back of the cornea.
Progression to Bullae: As the disease worsens, the cornea becomes waterlogged (edema). Eventually, fluid collects under the epithelium in blisters called "bullae."
Symptoms: Patients classically have blurry vision that is worst in the morning and clears up as the day goes on (due to moisture evaporation). When bullae rupture, it causes sharp pain and foreign body sensation.
Differentials: Viral ulcers cause focal dendrites, not diffuse guttae. Interstitial keratitis causes deep corneal scarring and vascularization.
Step 3: Final Answer:
The clinical progression from guttae to bullous keratopathy is pathognomonic for Fuchs’ endothelial dystrophy.
The combination of corneal "guttae" (early stage) and "bullous keratopathy" (late stage) describes the natural history of a specific posterior corneal dystrophy.
Step 2: Detailed Explanation:
Fuchs' Dystrophy: This is a progressive, inherited disease of the corneal endothelium. It is usually bilateral but can be asymmetric.
Pathophysiology: The endothelial cells fail to pump water out of the cornea properly. The hallmark early sign is "guttae"—beaten metal-like bumps on the back of the cornea.
Progression to Bullae: As the disease worsens, the cornea becomes waterlogged (edema). Eventually, fluid collects under the epithelium in blisters called "bullae."
Symptoms: Patients classically have blurry vision that is worst in the morning and clears up as the day goes on (due to moisture evaporation). When bullae rupture, it causes sharp pain and foreign body sensation.
Differentials: Viral ulcers cause focal dendrites, not diffuse guttae. Interstitial keratitis causes deep corneal scarring and vascularization.
Step 3: Final Answer:
The clinical progression from guttae to bullous keratopathy is pathognomonic for Fuchs’ endothelial dystrophy.
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