Bread Crumbs!

Type 1 (Classic) Granular Dystrophy

Bilateral, symmetrical, anterior stromal dystrophy

Autosomal dominant, TGFBeta1, 5q31

Type 2 is Avellino/ Combined granular-lattice dystrophy

Symptoms:

· Onset 1st decade

· Glare, photophobia

· Visual acuity is not affected in early stages

· Pain due to recurrent corneal erosions

Signs:

· Discrete white central anterior stromal opacities resembling bread crumbs/sugar granules/glass splinters in a radial/disc shaped/ Christmas tree pattern

· Stroma between opacities is clear

· Gradual increase in number and size of deposits with deeper and outward spread

· Opacities do not extend to the limbus

· Corneal sensation impaired

· Recurrent corneal erosions

Histology:

Amorphous hyaline deposits stain bright red with Masson Trichome

Treatment:

Excimer Laser Keratectomy

PK/DALK

Mnemonic for main corneal dystrophies abnormal deposits and staining

"Marylin Monroe Always Gets Her Men in L. A. County"

Macular dystrophy - Mucopolysaccharide - Alcian blue

Granular dystrophy - Hyaline materials - Masson trichrome

Lattice dystrophy - Amyloid - Congo red

Image from Rajan Eye Care Hospital

#ophthalmology #ophthal #cornea #cornealdystrophy #granulardystrophy