Cornea/Refractive Surgery Quiz 7

Scott Burk, MD/PhD | Massachusetts Eye and Ear Infirmary, Harvard Medical School

November 5, 1996
Figure 1
Figures 1-3. Anterior segment photographs of 3 different individuals with the same corneal condition.
Figure 2
Figure 3
Questions and Answers
1. What is your diagnosis?
Answer: Discrete milky white, granular deposits in the anterior stroma are characteristic of granular dystrophy.

2. Will this process extend to involve the entire cornea?
Answer: No, granular dystrophy does not extend to the limbus.

3. What is the inheritance pattern of this condition?
Answer: Autosomal dominant.

4. When does this condition become evident?
Answer: The disease is evident early in life, but patients remain asymptomatic for years.

5. What are the symptoms?
Answer: Slowly progressive visual loss, rarely below 20/200. Recurrent erosions are rare.

6. What would light microscopy SHOW in this condition?
Answer: Clumps of hyaline material concentrated in the anterior stroma that stains well with Masson's trichrome stain.

7. What treatment would you recommend?
Answer: In the early stages granular dystrophy no treatment is needed. When visual acuity is limited, penetrating keratoplasty offers a relatively good prognosis though the disease may recur after many years.