Conjunctival Lymphangiectasia Simulating Loa Loa.

Abstract

A 46-year-old woman presented with complaints of irritation in the OS for 1 year. Her ocular examination revealed normal vision and anterior segment except for an incidental finding of a worm-like lesion in the temporal conjunctiva. The lesion was transparent, linear in shape forming a complete loop, extending from the superotemporal conjunctiva to the inferior conjunctiva (Panel A). The plane of the lesion was conjunctival. The lesion showed no mobility with exposure to light or when touched with a cotton-tip applicator. Differential diagnosis of dead loa loa versus lymphangiectasia was made. Her peripheral blood smear did not reveal any microfilariae and had a normal cell count. Surgical excision revealed the lesion to be embedded within the conjunctiva and no worm came out. Only a segment of the lesion was sent for biopsy as there was no worm. Histopathology revealed hyperplastic conjunctival epithelium (Panel B; ×200) showing diffuse and intense expression with pan-cytokeratin antibody (Panel C; ×200). Subepithelial stroma showed thickened, dilated, and ectatic vessels (Panel D; ×400). The endothelial lining of vessels showed strong and intense expression with CD34 and podoplanin antibodies (Panels E and F; ×400) indicating lymphatic origin. The final diagnosis of conjunctival lymphangiectasia was made. Isolated conjunctival lymphangiectasia can be an incidental finding or associated with chemosis or persistent irritation. A trial of topical steroids can be given in symptomatic patients. Surgical excision with or without amniotic membrane graft or conjunctival autograft can be performed in nonresponsive cases. Anterior segment optical coherence tomography of conjunctival lymphangiectasia shows multiple subepithelial cystic spaces within the conjunctiva.