A rare case of bilateral granular corneal dystrophy with keratoconus and primary angle closure glaucoma.

A 41-year-old female presented with clinical features of bilateral granular corneal dystrophy (GCD) [Fig. 1a, b], keratoconus on Pentacam [Fig. 2a–d], and primary angle closure glaucoma. GCD with keratoconus is rarely reported.[1234] Although no evidence-based analysis has linked this association, many theories have been proposed, including abnormal synthetic activity of keratocytes and degeneration of defective basal epithelial cells, speculated to occur in both.[2] While GCD is clinically obvious, this case emphasizes the need to identify associated factors in effective planning and management. Documenting keratometry in GCD patients may aid in early diagnosis.

Figure 1

(a) Right eye: Slit section image showing stromal deposits in GCD. (b) Left eye: Diffuse slit-lamp image showing granular deposits in the central cornea. GCD = granular corneal dystrophy

Figure 2

(a, b) Pentacam image of the right and left eyes showing thinnest pachymetry corresponding with area of steepening and highest point of elevation. (c, d) Pentacam image of the right and left eyes showing Belin/Ambrósio enhanced ectasia display

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