Protruding Stromal Amyloid Breaching Bowman’S Membrane In Gelsolin-Associated Lattice Corneal Dystrophy Causing Contact Lens Intolerance

To describe a rare presentation of gelsolin-associated lattice corneal dystrophy in which stromal amyloid breached Bowman’s membrane and protruded anteriorly, producing mechanical ocular surface symptoms and contact lens intolerance.

Norfolk and Norwich University Hospital NHS Foundation Trust, United Kingdom.

A 74 year old woman with genetically confirmed gelsolin amyloidosis was followed for bilateral lattice corneal dystrophy with preserved visual acuity but progressive ocular irritation and inability to tolerate contact lenses. Slit-lamp examination demonstrated typical lattice changes with anterior stromal haze and a focal raised central lesion in the more symptomatic eye. Anterior segment OCT showed a hyper-reflective anterior stromal deposit breaching Bowman’s membrane and protruding above the corneal surface, disrupting normal contour. Given the functional impairment, superficial surgical excision was performed to restore surface regularity. Histopathology confirmed amyloid deposition with Congo red positivity. The procedure was uncomplicated. Postoperatively, corneal contour improved, symptoms resolved, and comfortable contact lens wear was restored without significant change in visual acuity.

Anterior protrusion of stromal amyloid through Bowman’s membrane is an uncommon but clinically important manifestation of gelsolin-associated lattice corneal dystrophy. Symptoms may be driven by mechanical surface irregularity rather than visual loss. Recognition of this presentation allows targeted superficial excision, which can restore comfort and contact lens tolerance without the need for keratoplasty.