Online Photo Diagnosis

By Gregory W. DeNaeyer, OD, FAAO

This photo shows the left cornea of a 27-year-old male who reported as a new patient for contact lens fitting. He reported no ocular or visual complaints. Other than myopia, the patient stated not having any other known ocular diagnosis or pertinent family ocular history. His best-correct visual acuity was 20/20 in both eyes. Slit lamp exam of the patient's right (Figure 2) and left corneas showed small white central opacities in the anterior stoma with clear intervening space. The patient was diagnosed with granular corneal dystrophy.

Figure 1

Figure 2

Granular dystrophy is an autosomal dominant dystrophy that presents by the second decade of life. Small, white opacities develop in the anterior stroma and are usually confined to the central cornea. Worsening of the dystrophy can result in the development of stromal haze in the space between opacities. Progressive and significant visual degradation may necessitate a corneal transplant.

The patient was successfully fit with soft contact lenses with resulting visual acuity of 20/20 in each eye. We educated him and his wife concerning the hereditary risk to their children.