eMedicine Specialties > Ophthalmology > Cornea

Dystrophy, Granular: Treatment & Medication

Author: William Trattler, MD, Miami Center for Excellence in Eye Care; Consulting Staff, Department of Ophthalmology, Miami Baptist Hospital
Coauthor(s): William Lloyd Clark, MD, Consulting Staff, Palmetto Retina; Natalie Afshari, MD, Assistant Professor, Cornea and Refractive Surgery, Department of Ophthalmology, Duke University Eye Center, Duke University Medical Center
Contributor Information and Disclosures

Updated: Mar 15, 2006

Treatment

Medical Care

  • When recurrent erosions occur with this condition, they are treated like any other form of recurrent erosion.
  • Under care of an ophthalmologist, bandage contact lens along with antibiotics can be prescribed; alternatively, patching with an antibiotic ointment can be used. Some physicians treat recurrent erosions with frequent antibiotic ointments while awake.
    • Once the acute episode of recurrent erosion has resolved, preventive treatment may include sodium chloride 5% drops or artificial tear lubricating drops during the day and lubricating ointment at bedtime.
    • If recurrent corneal erosions occur despite medical therapy, then excimer laser phototherapeutic keratectomy (PTK) may be considered.

Surgical Care

Excimer laser PTK is quite effective at removing opacities from the superficial cornea. When deep opacities are causing significant visual symptoms, corneal transplantation may be required.

  • Excessive corneal erosions or visual decrease from superficial opacities can be treated with PTK. Excimer laser PTK removes superficial opacities, smooths the corneal surface, and allows the epithelium to re-adhere more tightly.
  • If the visual acuity drops and most of the opacities are deep, lamellar or full-thickness corneal transplantation can be performed. Although the success rate for corneal transplantation is very high, granular deposits recur with time. Fortunately, when the deposits recur, they tend to be superficial, and amenable to treatment with excimer laser PTK.

Medication

Medical therapy for recurrent corneal erosions includes hypertonic saline, which is believed to increase adherence of epithelium to the underlying stroma. Lubrication, especially at bedtime, also may help prevent further corneal erosions.

Hypertonic saline drops

Dehydrates the epithelium, allowing it to better adhere to underlying stroma.


Sodium chloride 5% (Adsorbonac, Afrin Saline Mist, Muro 128)

Used for temporary relief of corneal edema.

Adult

Solution: 1-2 gtt in affected eye(s) tid/qid
Ointment: 0.25-0.5 inch to lower cul-de-sac qhs

Pediatric

Administer as in adults

Pregnancy

A - Safe in pregnancy

Precautions

May cause temporary burning and irritation upon use; if pain, change in vision, continued redness or irritation of the eye(s) occur, or if initial condition/problem worsens or persists, reevaluate therapy; do not use product if it changes color or becomes cloudy

Lubricating agents

Can moisten ocular surface and decrease frequency of recurrent erosions.


Artificial tears (Celluvisc, Murine, Refresh, GenTeal, Refresh PM, Lacri-Lube)

Contains equivalent of 0.9% NaCl and are used to maintain ocular tonicity. Acts to stabilize and thicken precorneal tear film and prolong tear film breakup time, which occurs with dry eye states.

Adult

Solution: 1 gtt to affected eye 4-8 times/d
Ointment: 0.25-0.5 inch to lower cul-de-sac qhs

Pediatric

Administer as in adults

Pregnancy

A - Safe in pregnancy

Precautions

Hyperemia, photophobia, stickiness of eyelashes, ocular discomfort or irritation may occur

More on Dystrophy, Granular

Overview: Dystrophy, Granular
Differential Diagnoses & Workup: Dystrophy, Granular
Treatment & Medication: Dystrophy, Granular
Follow-up: Dystrophy, Granular
Multimedia: Dystrophy, Granular
References
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References

  1. Albert D, Jakobiec F. Principles and Practice of Ophthalmology. Vol 1. 1994:26-49.

  2. Das S, Langenbucher A, Seitz B. Excimer laser phototherapeutic keratectomy for granular and lattice corneal dystrophy: a comparative study. J Refract Surg. Nov-Dec 2005;21(6):727-31. [Medline].

  3. Grunauer-Kloevekorn C, Brautigam S, Wolter-Roessler M. Molecular genetic analysis of the BIGH3 gene in lattice type I (Biber-Haab-Dimmer) and granular type II (Avellino) corneal dystrophy: is indirect mutation analysis for hot spots recommended?. Klin Monatsbl Augenheilkd. Dec 2005;222(12):1017-23. [Medline].

  4. Klintworth GK. Advances in the molecular genetics of corneal dystrophies. Am J Ophthalmol. Dec 1999;128(6):747-54. [Medline].

  5. Krachmer J. Cornea. Vol 2. 1996.

  6. Yamamoto S, Okada M, Tsujikawa M, et al. The spectrum of beta ig-h3 gene mutations in Japanese patients with corneal dystrophy. Cornea. May 2000;19(3 Suppl):S21-3. [Medline].

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Further Reading

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Keywords

granular dystrophy, corneal dystrophy, granular corneal dystrophy

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Contributor Information and Disclosures

Author

William Trattler, MD, Miami Center for Excellence in Eye Care; Consulting Staff, Department of Ophthalmology, Miami Baptist Hospital
William Trattler, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

William Lloyd Clark, MD, Consulting Staff, Palmetto Retina
William Lloyd Clark, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Natalie Afshari, MD, Assistant Professor, Cornea and Refractive Surgery, Department of Ophthalmology, Duke University Eye Center, Duke University Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Fernando H Murillo-Lopez, MD, Senior Surgeon, Unidad Privada de Oftalmologia CEMES
Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Hospital
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Eye Bank Association of America, Pennsylvania Medical Society, and Philadelphia County Medical Society
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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