A 43-year-old woman diagnosed with granular corneal dystrophy (GCD) type 2 on the basis of bilateral granular deposition in the corneal stroma ( Fig. 1 A) and the detection of a heterozygous R124H mutation of the transforming growth factor–β–induced gene ( TGFIB ) presented with ocular pain and conjunctival hyperemia in her left eye. Slitlamp examination showed swelling and congestion of the left conjunctiva associated with yellowish-white deposits in the bulbar region ( Fig. 1 B). Two weeks later, similar conjunctival lesions appeared in the lower portion of her right eye. Biopsy and histopathologic examination of the left conjunctival lesions revealed eosinophilic deposits in the lamina propria ( Fig. 1 C). The conjunctival deposits reacted with Masson’s trichrome stain ( Fig. 1 D) and Luxol fast blue but not with Congo red, suggesting the presence of hyaline but not amyloid. Treatment with betamethasone eyedrops attenuated the redness and swelling of the conjunctiva as well as induced regression of the protrusions in both eyes. Hyalin bodies are occasionally observed in the superficial layers of the conjunctival epithelium in the elderly, but not in patients younger than 79 years. Our case is very unusual because of the patient’s young age and the hyaline depositing mass in the conjunctival stroma. The corneal deposits of GCD type 2 have been shown to be composed of hyaline and amyloid. This is the first reported case of GCD type 2 associated with hyaline deposition in a tissue other than the cornea.
Atypical conjunctival hyaline deposition in a case of granular corneal dystrophy type 2
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