Unusual superficial stromal corneal deposits in IgG kappa monoclonal gammopathy

Unusual corneal stromal deposits at the level of Browman's membrane and superficial stroma were associated with severe photophobia and tearing as the initial signs of an IgG kappa monoclonal gammopathy. A corneal biopsy specimen showed superficial stroma areas that stained red with Masson trichrome stain. These deposits were positive for IgG and kappa chains. Histopathologic examination revealed focal disruption in Bowman's membrane with extension into the epithelium. Electron microscopy of the deposits disclosed parallel linear profiles compatible with immunoglobulin.