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Bread Crumbs!

Type 1 (Classic) Granular Dystrophy

Bilateral, symmetrical, anterior stromal dystrophy

Autosomal dominant, TGFBeta1, 5q31

Type 2 is Avellino/ Combined granular-lattice dystrophy


· Onset 1st decade

· Glare, photophobia

· Visual acuity is not affected in early stages

· Pain due to recurrent corneal erosions


· 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


Amorphous hyaline deposits stain bright red with Masson Trichome


Excimer Laser Keratectomy


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

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