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

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