|Year : 1974 | Volume
| Issue : 1 | Page : 30-32
Amyloid tumour of the lids
Ishwarchandra, PC Deshmukh, U Hardas
Department of Ophthalmology, Medical College, Nagpur, India
Department of Ophthalmology, Medical College, Nagpur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ishwarchandra, Deshmukh P C, Hardas U. Amyloid tumour of the lids. Indian J Ophthalmol 1974;22:30-2
Involvement of the conjunctiva and tarsal plate in primary or secondary amyloidosis is infrequent. It usually occurs in young adults between the age of 25 to 30 years and in two out of three cases, it is bilateral. The conjunctival involvement usually begins in the transitional fold extending from the conjunctiva of the lids and the globe. The mucous membrane appears yellow, transparent, waxy, avascular and may show swelling of considerable size, epithelium remaining normal. As the tarsal plate gets affected, it may grow as tumour of such a size that the patient can hardly open the eyes. Brief mention of the disease has been made in literature by various observers. Many cases of primary and secondary amyloidosis have been reported from India ,,,,. A case of tumour forming amyloidosis affecting the lids is reported from our department, because of its rarity.
| Case Report|| |
A Hindu female aged 17 years was admitted as an indoor case in our department on June 18, 1971 with the complaints of painless swellings affecting both lids of the right eye and the lower lid of the left eye. Initially it was noted to have started 5 years ago. Because of the swelling in the right upper lid, she experienced difficulty in opening the right eye. The patient was admitted for leprosy 12 years back for which she received institutional treatment. There was no history suggestive of a systemic disease like syphilis or tuberculosis or of a local disease suggestive of vernal catarrh or trachoma.
General examination revealed that the patient was suffering from non-lepromatous type of leprosy. There was no abnormality of cardiovascular, central nervous and respiratory systems. Liver and spleen were not palpable. There was no lymphadenopathy.
Local examination revealed no ocular manifestation of leprosy, except that the eye lashes and the eye brows were sparse. Conjunctival sensation was normal.
The palpebral conjunctiva in both the eyes over the swelling was congested but not ulcerated. There were no follicles or papilla, formation and no evidence of scarring was present. Fornices and bulbar conjunctiva were not affected. Corneal sensation was normal and there was no pannus formation. All the other structures of the eye were unaffected. The right upper lid was drooping and covered the upper one-third of the cornea. Visible swellings were noted to occupy the outer two-third of both the upper and lower lids. A smaller swelling was noted in the outer part of the left lower lid. The skin over the swelling was normal and free. The margins of the swellings were ill defined. The swelling was hard to feel and its surf ace was nodular and grossly irregular. The swellings were painless. Acuity of vision was recorded as 6/9 each eye. [Figure - 1].
A biopsy specimen of the tumour from the right eye showed chronic inflammatory cells, lymphocytes and plasma cells. Masses of collagenised tissue lie beneath the epithelial lining. Special stains for amyloidosis confirmed the diagnosis [Figure - 2].
In order to rectify the cosmetic deformity, a horizontal skin incision was given across the right upper lid, 5 mm. from the lid margin. It was observed that the fibres of orbicularis oculi were very much fragmented. The anterior surface of the tarsal plate was highly convex, rough and yellowish in its colour. diffusely thickened and hard to feel. The thickened tarsal plate was subtotally shaved out and it was noted that there was little bleeding during this procedure. The skin incision was closed.
Laboratory investigations were non-contributory.
| Discussion|| |
Amyloidosis is uncommon in India. Bhende and Patel  reviewed published cases of amyloidosis in Indians and could find only one case on a study of surgically removed specimen, the latter being the only example of localised amyloidosis in eye lids, reported by Aggrawal and Shrivastava  from this Medical College. Hyaline or amyloid degeneration may occur in two forms either as an incidental degenerative process appearing in pathological conditions or as a clinical entity sui-generis. Reimann et al recognised four varieties of amyloidosis-i) Primary ii) Secondary iii) Localised amyloid tumour iv) Amyloidosis associated with multiple myeloma. Of these, secondary amyloidosis associated with long continued infective conditions like tuberculosis, leprosy, osteomyelitis etc is the most common. Primary amyloidosis occurring in the absence of any predisposing disease, tends to involve the mesodermal tissues such as smooth and skeletal muscles, cardiovascular system and skin. Localised amyloidosis forming tumour like nodules have been described in many areas including the respiratory tract, conjunctiva, tongue etc. Its etiology being obscure and very often these are associated with local causes like chronic conjunctivitis, vernal catarrh and trachoma (being the most common).
| Summary|| |
A case of primary amyloidosis in a young girl presenting itself as localised amyloid tumour affecting the structures of the lids in both eyes is presented as a clinical entity suigeneris. The patient was an established case of leprosy but did not manifest any ocular signs. She did not have any local disease like trachoma or vernal catarrh.
| References|| |
Aggrawal, S. and Shrivastava, J.B., 1958, Brit. J. Ophthal, 42,
Bhende, Y.M., and Patel, S.M., 1959, Ind. J. Path. and Bact., 2, 286-292.
Bisaria, K.K., Garg, K.C. and Sud, S.D. 1967, Brit. J. Ophthal, 51,
Duke Elder Stewart, 1956, System of Ophthalmology, VIII,
588, Henry Kimpton, London.
lshwarchandra and Sharma K.D., 1960, J. Alt Ind. Ophthal. Soc. 8,
Jain N.S., 1960, Brit. J. Ophthal. 46,
Madan Gopal AN, 1962, Brit. J. Ophthal.
Mathur, S.P. and Mathur, B.P., 1959, Brit. J. Ophthal.
Pahwa, J.N. and Patney, H.L., 1962, XIX Concilium Ophthal. 11, 1111.
Reimann. H.A., Koucky, R.F. and Eklund, C.M., 1935, Amer. J. Path., 2,
[Figure - 1], [Figure - 2]