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BRIEF REPORT
Year : 2000  |  Volume : 48  |  Issue : 1  |  Page : 56-7

A rare case of both eyelids swelling: Isolated conjunctival amyloidosis


Head and Neck Service "B", Tata Memorial Hospital, Dr. Ernest Borges Road, Parel, Mumbai-400 012, India

Correspondence Address:
P Chaturvedi
Head and Neck Service "B", Tata Memorial Hospital, Dr. Ernest Borges Road, Parel, Mumbai-400 012
India
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Source of Support: None, Conflict of Interest: None


PMID: 11271940

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Keywords: Adult, Amyloidosis, complications, diagnosis, Biopsy, Conjunctiva, pathology, radiography, Conjunctival Diseases, complications, diagnosis, Diagnosis, Differential,


How to cite this article:
Chaturvedi P, Lala M, Desai S, Sanghvi V. A rare case of both eyelids swelling: Isolated conjunctival amyloidosis. Indian J Ophthalmol 2000;48:56

How to cite this URL:
Chaturvedi P, Lala M, Desai S, Sanghvi V. A rare case of both eyelids swelling: Isolated conjunctival amyloidosis. Indian J Ophthalmol [serial online] 2000 [cited 2020 Apr 1];48:56. Available from: http://www.ijo.in/text.asp?2000/48/1/56/14849

Amyloid is an eosinophilic, amorphous protein that has been reported to deposit in virtually any tissue or organ and when extensive, may attain tumourous proportions. We present a rare case where both the upper and lower palpebral conjunctiva were affected by amyloid deposition.

Indian J Ophthalmol 2000;48:56-57

Amyloidosis of the palpebral conjunctiva is a rare condition that results in chronic ocular discomfort.[1-3] Various treatment approaches such as conservative surgical excision, [1,2] cryotherapy, and superficial radiotherapy[4] have been attempted with partial success.

A 43-year-old man presented with diffuse swelling of both eyelids of 12 years? duration. He noticed the swelling first in the left lower eyelid, which had involved the upper eyelid for a year [Figure - 1]. There was no history suggestive of eye infections (such as trachoma, blepharitis, etc.), trauma, chronic systemic illness, neuropathy or familial involvement. Both palpebral conjunctiva were congested and the disease was entirely subconjunctival, sparing the bulbar conjunctiva. The disease was predominantly in the tarsal plates, and the overlying skin was stretched. Transconjunctival biopsy revealed deposition of acellular, pale, esinophilic, hyaline material beneath the conjunctival epithelium [Figure - 2]. There was a sprinkling of mature plasma cells and lymphocytes. On Congo red staining, the material exhibited congophilia that on polarization showed apple-green birefringence consistent with amyloid deposition. The birefringence was sensitive to potassium permanganate pretreatment, confirming the secondary nature of amyloid deposition. Haematological, biochemical and urinary parameters were within normal limits. Ultrasound examination of the abdomen and pelvis did not reveal any abnormality. Immunoelectrophoresis revealed normal electrophoretic pattern, absence of monoclonal band, normal immunoglobulin levels (IgA, IgM, IgG) and absence of Bence-Jones protein in the urine. CT-scan of the eye showed soft tissue mass in both the left eyelids with no intraorbital extension. Extraocular muscles, eyeball, retrobulbar area and optic nerve were normal.

Since we are aware that surgical excision may cause eyelid cicatrisation or secondary xerophthalmia, we explained the pros and cons of surgery to the patient. In view of the 12-year history and the lack of symptoms, the patient preferred to be kept under observation. One-year follow up did not reveal any significant increase in the size of the swelling.


  Discussion Top


Isolated amyloidosis of the conjunctiva is extremely rare.[1-3],[5], [6] This has previously been reported by few authors as an unusual cause of ptosis[1] and an uncommon complication of trachoma.[4] to our knowledge this is the first case report of an isolated conjunctival amyloidosis involving both eyelids. Even though this was a case of secondary amyloidosis, it is noteworthy that there was no history suggestive of chronic infection.

Patients with conjunctival amyloidosis typically have a long history of slowly enlarging tumefaction of the eyelids with multiple biopsies and surgeries performed.[2] Review of the literature shows that the treatment varied from conservative local excision, [1,2] and cryotherapy to superficial cobalt therapy.[5] The disease is known to recur locally[2] with persistent ocular complaints that could perhaps be attributed to conservative local excision. Systemic examination in all the patients was normal.[4] Aetiology and pathogenesis of the disease is still unclear. Surgery is still the gold standard of management, which should be as conservative,[1],[2] as possible, even though infrequent recurrences have been reported.[6]



 
  References Top

1.
Hill VE, Brownstein S, Jordon DR. Ptosis secondary to amyloidosis of the tarsal conjunctiva and tarsus. Am J Ophthalmol 1997;123:852-54.  Back to cited text no. 1
    
2.
O?Donnell B, Wuebbolt G, Collin R. Amyloidosis of the Conjunctiva. Aust N Z J Ophthalmol 1995;23:207-12.  Back to cited text no. 2
    
3.
Jain NS, Gupta AN. Amylodosis of the Conjunctiva. Br J Ophthalmol 1966;50:102-4.  Back to cited text no. 3
[PUBMED]    
4.
Pecora JL, Sambursky JS, Vargha Z. Radiation therapy in amyloidosis of the eyelid and conjunctiva: A case report. Am J Ophthalmol 1982;14:194-96.  Back to cited text no. 4
[PUBMED]    
5.
Chumbley LC, Peacock OS. Amyloidosis of the conjunctiva - An unusual complication of trachoma: A case report. South Afr Med J 1977;52:897-98.  Back to cited text no. 5
[PUBMED]    
6.
Smith ME, Zimmeman LE. Amyloidosis of the eyelid and conjunctiva. Arch Ophthalmol 1966;75:42-51.  Back to cited text no. 6
    


    Figures

  [Figure - 1], [Figure - 2]


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