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A 48-year-old man presents with bilateral corneal deposits
Digital Journal of Ophthalmology 2009
Volume 15, Number 4
November 27, 2009
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Shaminder S. Bhullar, MD | Krieger Eye Institute, Sinai Hospital
Gerami D. Seitzman, MD | Krieger Eye Institute, Sinai Hospital
Differential Diagnosis
The differential diagnosis of bilateral small, discrete, sharply demarcated grayish white opacities in the anterior central stroma should include all of the following: macular dystrophy, corneal dystrophy of Bowman’s layer, Avellino dystrophy, lattice dystrophy, Schnyder crystalline dystrophy, Fleck dystrophy and granular dystrophy. Macular dystrophy is an autosomal recessive disease, which typically presents with peripheral and central focal, grey-white, superficial stromal opacities with intervening corneal haze. Patients are typically symptomatic with decreased vision and often have recurrent erosions. Corneal dystrophy of Bowman’s layer presents as central white reticular opacification. These lesions predispose the patient to painful recurrent epithelial erosions, which may lead to scarring and a decrease in vision, a feature not present in our patient. Avellino corneal dystrophy may present similarly to our patient; however, these patients typically have corresponding glass-like branching lines seen in lattice dystrophy. Schnyder crystalline corneal dystrophy, a progressive stromal dystrophy, typically presents with central opacification, a dense corneal arcus and decreased corneal sensation, none of which were present in our patient. Fleck dystrophy may present as discrete, flat gray dandruff-like lesions. However, it occurs asymmetrically and typically involves the periphery as well. Granular corneal dystrophy presents with bilateral small, discrete, sharply demarcated grayish white opacities in the anterior central stroma with intervening clear areas. Although typically diagnosed by the characteristic clinical exam and patient history, this dystrophy can be confirmed by genetic testing. Histopathologically the granular deposits stain red with mason trichrome stain.(1)