In a healthy cornea, endothelial cells keeps the tissue from excess fluid absorption, pumping it back into the aqueous humor.

When affected by some reason, such as Fuchs' dystrophy or a trauma during cataract removal, endothelial cells suffer mortality or damage.

When endothelial cell counts drop too low, the pump starts failing to function and fluid moves anterior into the stroma and epithelium.

These characteristic malformations disrupt vision and create pain sensations.

Keratopathy occurs after cataract surgery, its incidence has decreased since the advent of intraoperative viscoelastic agents that protect the endothelium.