Lattice corneal dystrophy (LCD) type 1 is a progressive dystrophy characterised by accumulation of amyloid in the corneal stroma, which has the appearance of thin branching reflective lights, leading to deterioration of visual acuity [1]. Lattice dystrophy can be identified by histology with Congo red, green birefringence with polarising filter and by confocal microscopy (IVCM) [1]. Unilateral lattice dystrophy (ULD) cases have been reported in the literature [2,3,4,5] associated with different pathogenic variances [3, 5], including the p.(His572del), which was suggested to cause unilateral presentation [3].

Our findings provide further evidence that asymptomatic eyes in ULD may have sub-clinical disease, and that in early stages ULD can only be identified by IVCM, which is necessary for correct diagnosis. We also show that sub-clinical disease may develop into symptomatic disease in the long term and advise that patients need to be counselled that their unaffected eye may develop disease.

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