Glare, foreign body sensation, decreased vision or recurrent painful epithelial erosions
In young adults, vision is usually unaffected
By the age 40, visual acuity will decrease insidiously as the lesions increase in size, multiply, coalesce, and distribute to a deeper stroma
Signs:
Bilateral
Relatively symmetric, discrete, well demarcated crumb-like, white-grey granules in the axial anterior central stroma sparing the 1-3 mm of periphery cornea
Stroma in between lesions remains clear
Usually becomes apparent with recurrent corneal erosions during the first and second decade of life
Management
Superficial debridement, lamellar keratoplasty, and excimer laser phototherapeutic keratectomy usually provide good outcomes.
Penetrating keratoplasty is rarely required but indicated in advanced cases with extensive stromal involvement and significant decrease in visual acuity.
Recurrent granular dystrophy may occur after keratoplasty.