Conjunctival Lesions Research Articles

Fluorescence Confocal Microscopy for Ex Vivo Diagnosis of Conjunctival Tumors: A Pilot Study

To evaluate the potential use of fluorescence confocal microscopy (FCM) for exvivo diagnosis and excision margin assessment of conjunctival neoplasms. Validity study. setting: Single institution. Consecutive patients with clinically suspicious conjunctival lesions. Conjunctival lesions were excised in toto using a standard "no-touch technique" by a single surgeon (A.I.). Collected specimens were examined with a commercially available laser scanning fluorescence confocal microscope after immersion in a 0.6mM solution of acridine orange dye for 10-20 seconds. Specimens were subsequently processed with standard histologic analysis. FCM diagnosis of the nature and extension of conjunctival lesions. Sixteen consecutive patients were included in the study (11 male, 5 female; mean age 58.1 ± 26.1 years, range 10-90 years). The median time needed to process and analyze a sample with FCM was 15minutes. Eleven of 16 lesions were identified by FCM as squamous (2 benign papillomas, 2 grade 2 conjunctival intraepithelial neoplasias, 7 insitu squamous carcinomas) and 5 as nonsquamous (1 pingueculum, 1 dermolipoma, 2 melanocytic nevi, 1 melanoma). In all cases FCM was able to detect horizontal and vertical extension of the lesion. All FCM findings were confirmed by corresponding subsequent histologic examination. FCM provides a fast exvivo preliminary diagnosis of suspicious conjunctival lesions with good histologic details and margin assessment, and may represent a novel tool for intraoperative and postsurgical management of conjunctival tumors. This is the first study to investigate exvivo FCM application in ophthalmology.

Clinical features and prognosis of conjunctival lymphoid hyperplasia

Background Primary conjunctival lymphoid hyperplasia exhibit atypical clinical symptoms and easy to cause misdiagnosis and mistreatment.Understanding the clinical characteristics of primary conjunctival lymphoid hyperplasia is of an important clinical significance. Objective This study was to analyze the clinical characteristics and therapeutic outcome of patients with primary conjunctival lymphoid hyperplasia. Methods The medical records of 20 patients with primary conjunctival lymphoid hyperplasia who was treated in Beijing Tongren Hospital from January 2012 to December 2014 were retrospectively analyed.The age, symptoms, therapy, prognosis, histopathological features and immonochemistry results were reviewed, and the treating approach targeting to different types of conjunctival lymphoid hyperplasia was evaluated.The fellow-up duration was 1-2 years. Results Age of the patients ranged from 27 to 83 years old.The lesions were classified as benign lymphocytic hyperplasia, atypical lymphoid hyperplasia and lymphoma.Majority of lesions located in fornix conjunctiva tissue (90%). Follicle-like appearance was seen in the benign lymphocytic hyperplasia, and pink elavation was exhibited at the bulbar conjunctiva in the atypical lymphoid hyperplasia.A diffuse salmon fish like appearance in conjunctiva was the primary feature of conjunctival lymphoma.Histopathological examination showed that conjunctival benign lymphocytic hyperplasia had follicle-like tissue in lesions, atypical lymphoid hyperplasia exhibited diffuse lymphocyte filtration, and conjunctival lymphoma appeared monocyte filtration.The 3 tpyes of lesions also could be differentiated by immunochemistry.The medicine was applied in the eyes with benign lymphocytic hyperplasia, and the combination of resection of lesions with conjunctival tissue or amniotic membrane transplantation was used for the atypical lymphoid hyperplasia or lymphoma eyes.No recurrence of the lesions was found during fellow-up duration. Conclusions The clinical manifestations of conjunctival lymphoid hyperplasia lesions are varied, and it is easy to be confused with chronic ocular surface diseases.Pathology and immunochemistry are helpful for the differential diagnosis.The treating regimen is dependent on the lesion type.Most patients have a favorable prognosis with treatment. Key words: Conjunctival diseases/pathology; Conjunctival neoplasms/diagnosis & therapy; Hyperplasia; Lymphoid tissue/pathology; Lymphoma/pathology; Retrospective studies; Humans

Nasal dissemination of a single-clone IgH-rearranged conjunctival MALT lymphoma through the nasolacrimal duct: A case report.

The aim of the present study was to report a rare case of single-clone, immunoglobulin heavy chain (IgH)-rearranged mucosa-associated lymphoid tissue (MALT) lymphoma in the conjunctiva, with nasal cavity dissemination through the nasolacrimal duct. A 24-year-old female was diagnosed with MALT lymphoma of the nasal cavity at the Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University (Tapei, Taiwan) in October 2008. A biopsy of the relapsing conjunctival lesion revealed a MALT lymphoma by pathological staining, while a single-clone, IgH-rearranged tumor lesion in the nasal cavity and conjunctiva was confirmed using continuous sinus computed tomography scans and polymerase chain reaction. Tumor lesions were negative for Helicobacter pylori and Chlamydia infection, but exhibited bilateral neck lymph node dissemination. A combination of radiation therapy (a total dosage of 46.8 Gray, in two phases covering the left lacrimal sac, nasal cavity and bilateral neck region) and topical ciprofloxacin plus steroid (0.3% ciprofloxacin 4 times a day and betamethasone eye ointment before sleep for 1 month) was provided as an effective therapeutic strategy, and no recurrence was found in the next 3 years. The nasolacrimal duct serves as a channel for conjunctival tumor spreading and is easily neglected. IgH-involved translocation in MALT lymphoma is a factor in the progression of the disease, and aggressive combination therapy is essential for a high-risk, disseminated IgH-rearranged MALT lymphoma.

The Hidden Salmon Patch: Ocular Lymphoma Mistaken as Vogt Koyanagi Disease

Ocular inflammation from various causes may have similar clinical presentation thus careful clinical evaluations are mandatory particularly when the disease appear to be resistant to treatment. This paper reports a case of ocular lymphoma which was initially treated as Vogt Koyanagi Harada disease at a different centre. A 65-year-old Sudanese man complained of gradual worsening left eye vision. Careful ocular and slit lamp examination revealed a conjunctival lesion with choroidal infiltration as well as exudative retinal detachment. Computed tomography scan (CT scan) showed left eye axial proptosis, and a homogenous enhancing mass at the posterior coat of the globe. Tissue biopsy of the conjunctival lesion revealed marginal Zone B cell (MALT type), low grade, non-Hodgkin’s lymphoma. AS the ocular signs and symptoms progressed, chemotherapy was initiated. The proptosis, exudative retinal detachment, disc hyperemia and swelling improved after chemotherapy. The post treatment CT scan showed reduction of the posterior ocular coat mass. The possibility of malignant lymphoma should be considered in patients with resistant uveitis despite administration of corticosteroid. Ocular lymphoma is an indolent tumour with good prognosis. Careful ocular examination, adequate imaging studies followed by early surgical biopsy will contribute to early diagnosis.

Clinical Features of Ocular Sarcoidosis in Patients with Biopsy-proven Pulmonary Sarcoidosis in Serbia

ABSTRACTPurpose: To analyze clinical characteristics of ocular sarcoidosis in a group of biopsy-proven sarcoid patients treated at the single referral center for sarcoidosis in Serbia.Methods: A prospective study carried out on 88 biopsy-proven sarcoid patients between January 2012 and December 2014. All patients underwent complete ophthalmological examination.Results: Ocular sarcoidosis was present in 32 patients (36.4% of all) and included: eyelid skin lesions (2.3%); orbital inflammation (2.3%); conjunctival lesions (7.9%); anterior uveitis (2.3%); intermediate uveitis (1.1%); posterior uveitis (15.9%); panuveitis (5.7%), and neuro-ophthalmologic manifestations (9.1%). Complications included cataract (20.4%); glaucoma (5.7%); cystoid macular edema (3.4%); epiretinal membrane formation (4.5%); macular atrophy (2.3%); and choroidal neovascularization (1.1%). Binocular visual impairment was present in one patient (1.1%), due to complications of posterior uveitis (macular scars).Conclusions: Patients in Serbia demonstrated ocular sarcoidosis as the first most common site of extrapulmonary sarcoid manifestations, with more often neuro-ophthalmologic lesions than in other European populations.

Conjunctival Lesions and Vision Impairment After Gastrointestinal Surgery.

A woman in her early 40s sought ophthalmological care after a referral from an optometrist for bilateral eye pain, substantial eye watering, bilateral conjunctival lesions, and decreased vision. What would you do next?

Effets secondaires cutanés de l’association télaprévir/peg-interféron/ribavirine pour le traitement de l’hépatite C chronique : étude prospective d’une cohorte multicentrique

Telaprevir, sale of which was suspended, has been approved in combination with pegylated interferon and ribavirin (triple therapy) in the treatment of chronic hepatitis C virus (HCV). Skin eruptions and isolated cases of severe cutaneous adverse reactions (SCAR) have been reported. Our aim was to assess the incidence of skin eruption and the clinical characteristics of mucocutaneous adverse events (AE), and to identify potential risk factors for telaprevir-associated skin eruption. A prospective observational multicenter follow-up cohort study with monthly controls by a dermatologist and additional examinations in case of any undercurrent AE. Among the 48 enrolled patients, the incidence of skin eruption was 58.4%, consisting mainly of maculopapular and eczematous lesions and only one case of SCAR. Telaprevir was discontinued in 6% of patients due to severe rash, whereas peginterferon and ribavirin were continued. The median time to onset of rash following telaprevir initiation was 25 days (range: 3-79 days). The rash was preceded by skin dryness and associated with pruritus in 100% and 90% of patients, respectively. Of those presenting with skin eruption, 37.5% also complained of conjunctival or oral lesions, or of anorectal symptoms. Neither a past history of dermatological conditions nor sociodemographic or viral status was predictive factor for skin rash. Telaprevir-related dermatitis has a high incidence but is mostly of mild intensity. In most cases, tri-therapy was continued under close dermatological follow-up allowing rapid detection of rare instances of severe drug eruptions. Ribavirin and Interferon were thus continued even in the event of diffuse eruptions, enabling confirmation of the causative role of telaprevir in these eruptions.

Conjunctival Hyperemia and Targetoid Lesions on Trunk and Extremities.

Conjunctival Hyperemia and Targetoid Lesions on Trunk and Extremities.

Reconstrucción palpebral en niño con xeroderma pigmentoso

Clinical caseSeven-year-old male patient, affected by xeroderma pigmentosum (XP) who was referred to ophthalmology due to the presence of numerous tumours in his left eye that affected the eyelids and conjunctiva.He had a tumour in his lower eyelid that affected the free edge, creating a secondary ectropion, and several lesions with a melanocytic appearance in conjunctiva.A resection of the eyelid tumour and the conjunctival lesions were performed by placing a skin graft and amniotic membrane, respectively, as covering. DiscussionXP patients have high probability of developing eye tumours. A thorough ophthalmic examination is necessary to establish an early diagnosis.

The usefulness of measuring tear periostin for the diagnosis and management of ocular allergic diseases

Chronic ocular allergic diseases such as vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC) are accompanied by serious comorbidities; however, the underlying pathogenesis remains obscure. Furthermore, diagnosing conjunctival lesions in patients with atopic dermatitis and estimating the severity in AKC are important for the treatment of ocular allergic diseases. We addressed whether periostin, a novel mediator and biomarker in allergic inflammation, is involved in the pathogenesis of ocular allergic diseases and whether periostin can be a biomarker for these diseases. We investigated tear periostin in patients with seasonal allergic conjunctivitis (SAC), VKC, and AKC and allergic patients without conjunctivitis and compared it with tear IL-13 and serum periostin. Furthermore, in patients with AKC, we measured tear periostin before and after topical treatment with tacrolimus. Tears from patients with ocular allergic disease showed significantly high periostin levels than did tears from allergic patients without conjunctivitis and from patients with AKC, VKC, and SAC in descending order. Tear periostin was associated with serious comorbidities such as large papilla formation and corneal damage in AKC, although both tear IL-13 and serum periostin had little to no such abilities. Furthermore, after topical tacrolimus treatment, tear periostin tended to decrease in most patients with AKC along with their clinical improvement. Periostin produced in conjunctival tissues stimulated by IL-13 may contribute to the pathogenesis of ocular allergic diseases. Furthermore, tear periostin can be potentially applied as a biomarker to diagnose conjunctivitis in allergic patients and to evaluate disease severity as well as the efficacy of treatments in AKC.

Melanoma da conjuntiva localizado em pálpebra superior

Melanoma of the conjunctiva (MC) is a tumor that can affect the next bulbar conjunctiva to the limbus, conjunctiva, eyelid, forniceal in plica or caruncles region, which may originate from melanosis areas acquired primary with atypia, conjunctival nevus areas, and no local lesions. Clinically it presents itself as a mass or a high pigmented conjunctival lesion. This Study aimed at describing a case of conjunctival melanoma multifocal from preexisting pigmented nevus. Histopathological diagnosis and staging of early conjunctival lesion is extremely important to designate the management of patients.

Practice Patterns Analysis of Ocular Proton Therapy Centers: The International OPTIC Survey

To assess the planning, treatment, and follow-up strategies worldwide in dedicated proton therapy ocular programs. Ten centers from 7 countries completed a questionnaire survey with 109 queries on the eye treatment planning system (TPS), hardware/software equipment, image acquisition/registration, patient positioning, eye surveillance, beam delivery, quality assurance (QA), clinical management, and workflow. Worldwide, 28,891 eye patients were treated with protons at the 10 centers as of the end of 2014. Most centers treated a vast number of ocular patients (1729 to 6369). Three centers treated fewer than 200 ocular patients. Most commonly, the centers treated uveal melanoma (UM) and other primary ocular malignancies, benign ocular tumors, conjunctival lesions, choroidal metastases, and retinoblastomas. The UM dose fractionation was generally within a standard range, whereas dosing for other ocular conditions was not standardized. The majority (80%) of centers used in common a specific ocular TPS. Variability existed in imaging registration, with magnetic resonance imaging (MRI) rarely being used in routine planning (20%). Increased patient to full-time equivalent ratios were observed by higher accruing centers (P=.0161). Generally, ophthalmologists followed up the post-radiation therapy patients, though in 40% of centers radiation oncologists also followed up the patients. Seven centers had a prospective outcomes database. All centers used a cyclotron to accelerate protons with dedicated horizontal beam lines only. QA checks (range, modulation) varied substantially across centers. The first worldwide multi-institutional ophthalmic proton therapy survey of the clinical and technical approach shows areas of substantial overlap and areas of progress needed to achieve sustainable and systematic management. Future international efforts include research and development for imaging and planning software upgrades, increased use of MRI, development of clinical protocols, systematic patient-centered data acquisition, and publishing guidelines on QA, staffing, treatment, and follow-up parameters by dedicated ocular programs to ensure the highest level of care for ocular patients.

A Clinicopathological Study of Various Conjunctival Lesions in Children

ABSTRACT Conjunctival cysts are of a common occurrence in clinical parlance. These tend to be mostly asymptomatic. However, the underlying cause may be vision threatening. Thus, we conducted a clinicohistopathological study of conjunctival cysts in pediatric age group who presented to our outpatient department in Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India. The aim was to analyze the risk factors, clinical presentation, treatment modalities, and a certain type of cysts in order of their frequency. Significant history, detailed ocular examination, and relevant investigations that were carried out in 10 cases of conjunctival lesions were noted. The management was done and the histopathological examination (HPE) reports were charted. Despite a similar clinical presentation, HPE revealed varied diagnosis. These comprised choristomatous cysts (4), subconjunctival cysticercosis (2), inclusion cysts (2), inflammatory cyst (1), and capillary hemangioma (1). Conjunctival cysts are not just a cosmetic blemish. A detailed ocular examination, early diagnosis, and treatment can help prevent various vision-threatening complications. How to cite this article Goel J, Prasad S, Dokania A. A Clinicopathological Study of Various Conjunctival Lesions in Children. Int J Adv Integ Med Sci 2016;1(4):143-147.

Pterigio e sua abordagem cirúrgica com membrana amniótica

The pathogenesis of pterygium is strongly correlated with ultraviolet light exposure, dryness, chronic inflammation, and wind and dust exposure. Substances that cause irritation are also considered predisposing factors for the elastic degeneration of stromal collagen and subepithelial fibrovascular tissue. The prevalence of this condition progressively increases toward the equator line. The medical community and literature consider conjunctival transplantation the best surgical method for the correction of pterygium. Here we report the experience of our research team in performing amniotic membrane grafting in approximately 6,000 cases since 1996. The advantages of this method include sparing of the patient’s conjunctiva, the achievement of a recurrence rate similar to that with free conjunctival transplantation ± 4%, an aesthetic appearance similar to or better than that with transplantation, and the continuous supply of amniotic tissue. The techniques used in the past 4 years include parabulbar anesthesia with L-bupivacaine, wide excision of the pterygium body, removal of the pterygium head via dissection or pulling out, application of mitomycin 0.02% for 2 min, thorough washing of the area with saline, and use of glue to fix the amniotic membrane patch. Cases of primary, recurrent, or extensive pterygium, as well as double pterygium (nasal or temporal), which require the use of a large amount of tissue, are easily corrected with amniotic membrane patches but cannot be treated with conjunctival patches because of the amount of tissue required. Amniotic membrane patches are prepared using placentas obtained from cesarean deliveries in patients who received full prenatal care and who were tested for hepatitis, syphilis, and HIV. The patches are placed onto pieces of filter paper and stored in a refrigerator, soaked in a solution of antibiotic and glycerin 100%, and later hydrated with either saline or Ringer’s solution during surgery. The amniotic membrane should be placed on the stromal side of the eye surface (graft), and this surface can serve as a basal membrane for the growth of new conjunctival tissue, with a template indistinguishable from that of the normal conjunctiva. The postoperative procedures include the use of occlusive dressing as well as eyedrops and a topical steroid–antibiotic combination for 3 days, and the use of eyedrops and a topical combination for 1 week after dressing removal. The controversies in pterygium surgery include the following: Anesthesia: The types include retrobulbar, peribulbar, parabulbar (our recommendation), subconjunctival, topical, and general anesthesia. After years of testing multiple modalities, we have demonstrated that parabulbar anesthesia using 3 mL of L-bupivacaine without additives yields a little more comfort in the postoperative period characterized by intense symptoms. Postoperative period: We use nonsteroidal anti-inflammatory drugs in conjunction with paracetamol/codeine, oral dipyrone (every 4 hours), and an occlusive dressing with a topical steroid–antibiotic combination for 3 or 4 days, after that, the dressings are removed, and the eye drops and topical combination are used for 7 days. Subsequently, only a lubricant and a low-penetration corticosteroid, such as Fenometalona or loteprednol etabonate, are used. Glue or sutures: The use of glue or sutures for the fixation of patches (conjunctival and amniotic) is controversial. The sole use of glue, preferably Tissucol® (a combination of fibrinogen, aprotinin, and thrombin from Baxter®), for 3 years has yielded the best results. However, we used nylon 10-0 sutures for several years before using glue. Some surgeons use four stitches in addition to glue; however, our experience dictates that suturing is not required when the amniotic membrane is glued. Amniotic membrane: The amnion, is the inner portion of the amniotic membrane and has an avascular stromal matrix. The amniotic membrane has a composition similar to that of the conjunctiva, and it is considered an ideal substrate to ensure the growth of conjunctival tissue, as well as to support a conjunctival patch in cases where frequent recurrence demands full-fledged surgical treatment. Amniotic tissue is used to reconstruct the conjunctiva in pterygium exeresis and other conjunctival lesions because it facilitates epithelization, does not change the phenotype of the conjunctiva, reduces inflammation, and stimulates vascularization and scarring, which are critical events after pterygium surgery. It is also important to note the easy availability of this tissue and the possibility of preservation of the conjunctiva for other procedures, including conjunctival flap covering and glaucoma surgery; in addition, the use of this tissue yields excellent aesthetic and functional results and a low recurrence rate. Figures 1 to 8 show a case of extensive pterygium, which covered the cornea of both eyes, albeit the left eye less extensively, and the outcome.

Conjunctival Dysplasia and Atypical Secondary Acquired Melanosis in Xeroderma Pigmentosum

Xeroderma pigmentosum (XP) is a rare genetic disease associated with hypersensitivity to ultraviolet radiation resulting in cutaneous, ocular and neurological abnormalities. Ocular involvement typically includes photophobia, keratitis, corneal opacity and atrophy of the eyelids, along with carcinomas and melanomas. We report a rare case of conjunctival dysplasia and atypical secondary acquired melanosis in a patient with XP. A 9 year old Indian boy with a history of XP presented with conjunctival lesions over the course of one year. The ocular involvement manifested as conjunctival actinic keratosis/epithelial dysplasia and atypical secondary acquired melanosis. To the best of our knowledge, atypical secondary acquired melanosis has not previously been reported in association with XP in the literature. We present our clinical and histopathological findings of conjunctival dysplasia and atypical secondary acquired melanosis in this patient. Although acquired melanosis with atypia is known to occur and is often reported as a cutaneous manifestation of XP, it is rarely reported as a conjunctival manifestation in XP. It is possible that the early acquired melanosis is overshadowed by more visible conjunctival intraepithelial neoplasia (CIN) lesions.

Conjunctival oculosporidiosis: A case report from a nonendemic zone in India

Oculosporidiosis or rhinosporidial infection of eye, a rarely encountered disease outside the endemic coastal areas of South India, is caused by Rhinosporidium seeberi. A 12-year-old patient presented with polypoidal conjunctival lesion of the right eye in a tertiary care hospital at West Bengal, India. Excision of the lesion followed by microbiological and histopathological examination confirmed the unique infectious etiology of the lesion. Oculosporidiosis should be included in the differential diagnosis of conjunctival polypoidal lesions even in nonendemic areas because misdiagnosis and improper management may lead to increased incidence in the same zones.

Long Term Outcome of Surgical Excision of Conjunctival Melanoma Combined with Mitomycin C Use: A Case Report

Purpose: To report a case of conjunctival melanoma (CM) treated with excision and adjuvant mitomycin C. Methods: This is a case report of a 51-year-old female with conjunctival melanotic lesion (10.5 × 5 mm), that was treated with complete surgical excision, combined with perioperative and intraoperative use of mitomycin C 0.02%. Lymphoscintigraphy with 0.3 mCi of technetium Tc-99m sulfur colloid and sentinel lymph node biopsy were also performed. Results: Histological and immunohistochemical staining of the excised melanotic lesion [S-100 (+), Melan (+), Tyrosinase (+), HMB 45 (+)] confirmed the clinical diagnosis of Conjunctival Melanoma. Moreover, lymphoscintigraphy and sentinel lymph node biopsy were negative for tumor metastasis. Ten years postoperatively, there were neither signs of tumor recurrence or metastasis nor late postoperative complications due to mitomycin C. Conclusions: Complete surgical excision combined with perioperative and intraoperative MMC 0.02% was safe and effective in preventing local recurrence in a case of conjunctival melanoma.

Conjunctival Involvement of T-Cell Lymphoma in a Patient with Mycosis Fungoides.

Background. Ocular involvement in mycosis fungoides (MF) cases occurs in one-third of patients with the eyelid being the most frequent site affected; however, conjunctival involvement is rarely reported. Herein, we report a rare case of conjunctival involvement of MF. Case Presentation. A 66-year-old man who was previously diagnosed with MF in 2010 and was treated presented in 2014 complaining of foreign body sensation and redness in both eyes. Slit lamp examination of both eyes showed erythematous conjunctival growth that extended circumferentially. Physical examination revealed erythematous skin lesions on different body parts. Conjunctival biopsy was performed and revealed a dense, highly polymorphic lymphocytic population. The immunophenotype demonstrated a neoplastic T-cell origin consistent with MF. A diagnosis of conjunctival involvement by MF was made. The conjunctiva was treated with radiotherapy resulting in tumor regression. There were no recurrences at the 6-month follow-up. Conclusion. T-cell lymphoma should be considered in patients with a history of MF presenting with conjunctival and skin lesions.

Primary Conjunctival Tuberculosis-A Rare Presentation

Tuberculosis is an infectious disease, commonly affecting the lungs. However, tuberculosis primarily affecting the conjuctiva is rare. Symptoms and signs of unilateral conjunctivitis may masquerade as primary conjunctival tuberculosis. In an endemic country like India, laterality, chronicity and non-resolution of symptoms with steroids are indications for pursuing a biopsy earlier than later. We report a case of 10 year old boy who presented with left eye discharge, redness with itching and a 1.5 x 1.0 cm palpebral growth for one month duration. Excision biopsy of the palpebral conjunctival lesion revealed necrotizing granulomatous inflammation suggestive of tuberculosis. Systemic examination showed no abnormality. He was started on anti-tubercular therapy. There was complete resolution of sign and symptoms with the initial treatment of 2 months duration.

Ectropion and Conjunctival Mass in a Patient with Primary Bilateral Conjunctival Amyloidosis.

Background. Amyloidosis is a group of disorders characterized by deposition of an extracellular protein, known as amyloid, in an abnormal fibrillar form with highly characteristic histopathologic staining properties. The clinical presentation can vary from a focal, localized lesion where amyloidosis has minor clinical consequences to extensive systemic disease that can involve any organ system of the body. Ocular amyloidosis can occur as a localized lesion or as a part of a systemic disorder. Conjunctival amyloidosis is an uncommon condition that is rarely associated with systemic disease. It may be a manifestation of an immunologic disorder. Case Report. We report the case of a patient with bilateral conjunctival amyloidosis who was referred to us with the suspicion of a malignant conjunctival lesion. Examination of both eyes showed a yellow-pink mass with prominent intrinsic vessels, subconjunctival hemorrhage, and ectropion of the left lower eyelid. Diagnosis of primary localized conjunctival amyloidosis was made based on histopathologic evaluation of incisional biopsy and negative systemic work-up. Conclusion. Ocular amyloidosis is a rare disease that is slowly progressive and has a wide variety of clinical presentations. Consequently, the clinical diagnosis is often overlooked or delayed. Definitive diagnosis is achieved through histopathologic evaluation of biopsy specimen.