Figures 1-3. Anterior segment photographs of 3 different individuals with the same corneal condition.
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.