|Year : 1954 | Volume
| Issue : 2 | Page : 45-47
Amyloidosis of conjunctiva
Pashpati N Wahi, PN Wahi, KN Mathur
Department of Pathology and Ophthalmology, S. N. Medical College, Agra, India
Pashpati N Wahi
Department of Pathology and Ophthalmology, S. N. Medical College, Agra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Wahi PN, Wahi P N, Mathur K N. Amyloidosis of conjunctiva. Indian J Ophthalmol 1954;2:45-7
Review of the literature brings out the infrequency of involvement of conjunctiva in primary or secondary amyloidosis. Brief mention of the disease has been made by Fuchs (1919), de Schweintz ( 1921 ), Collins and Mayo ( 1925 ), Wolff (1935), Berens ( 1936), Duke Elder ( 1938 ), Wiener ( 1946) and Ferdinand et al (1952). Few cases have been actually reported in the literature. Elles ( 1945 ) reported amyloid disease of the conjunctiva in a 38 year old woman who had mild conjunctivitis of the right eye for two years and hard induration of the lower lid for 3 or 4 months. Redi ( 1948) reported two cases of amyloidosis of the heart and conjunctiva. Srinivasan ( 1949) reported a case of amyloid degeneration of conjunctiva in a 30 year old male with trachoma.
Amyloidosis may manifest itself in the conjunctiva as a primary or secondary disease. Most of the cases reported have followed or complicated trachoma. The following case is an example of a tumour forming amyloidosis and is of special interest not only because of its rarity but because the patient was admitted as a case of growth of the conjunctiva and gave no history or showed any evidence of conjunctival irritation or trachoma. Clinical evidence of amyloidosis elsewhere in the body was also not available. The extreme degree of rarity of this condition warrants the report of a single case.
| Case Report|| |
G. D.. 20 years old, Hindu female, was admitted to the S. N. Hospital, Agra, with complaints of progressively increasing swelling of the left lower lid for the last 4 years for which she had received no treatment. There was no pain and no diminution of vision. She was married six months back and did not give any history of venereal disease, tuberculosis or chronic suppurative lesion.
Systemic examination did not show any positive findings. Liver and spleen were not enlarged. Cardiac system was normal. W. R. was negative.
Examination of the eyes showed that the left lower lid was swollen. The lids were heavy and due to mechanical ptosis it was difficult for the girl to keep the eye open. The palpebral fissure was very small and it was not possible to evert the lids completely. There was no congestion of the overlying skin which moved freely over the swelling. The swelling was hard to touch and moved with the lid. The lid margins were normal. The conjunctiva looked pale and waxy. In the left eye on the conjunctival side there was a tubular mass of pale waxy tissue occupying the lower fornix and extending right upto the inner canthus.
The bulbar portions of the conjunctiva and cornea were normal. Pupil was active. Tension was normal. Media were clear and fundus showed nothing abnormal. The movements of the eyeball were normal in all directions. The other eye evidenced no abnormality.
Trachoma was not marked clinically in this case and there was no pannus. Conjunctival smear was negative.
A biopsy was taken from the mass at first, and then the mass in the lower lid was removed and sent to the pathologist for examination.
Gross examination of the removed tumour mass showed a soft pink mass of tissue measuring 3.5 x 2 x 1.2 cm. The surface was slightly granular. The cut surface was homogeneous and pink.
Sections of the first biopsy specimen from the conjunctiva showed with haematoxylin and eosin stain a stratified covering epithelium and a structureless hyalinized pink staining material was seen deposited in clumps below the epithelium. Selective staining with methyl violet and iodine gave the staining reaction of amyloid. The walls of the capillaries did not reveal this material. Examination of the subsequently removed tumour mass did not reveal any epithelium. The whole mass as stained by haematoxylin and eosin consisted of a cellular pink staining homogeneous substance, which gave the special staining reaction for amyloid. The capillaries were prominent and were seen surrounded by the amyloid material in a ring like manner. On the basis of the above findings a diagnosis of amyloidosis of conjunctiva was made. [Figure - 1].
| Comments|| |
This case, clinically diagnosed as a growth affecting the left lower lid is one of primary amyloidosis of conjunctiva and fulfills the most important criteria of this condition in that the patient gave no history or evidence of any pre-existing disease which is capable of bringing about the formation of amyloid. Amyloid degeneration of conjunctiva usually follows local chronic infections like trachoma, but the cause and effect relationship between the two is not established. Like primary systemic amyloidosis elsewhere, it may also be a primary affection of the eye.
Primary systemic amyloidosis is a rare disease of unknown cause. Lubarsch (1929) suggested that the condition differs from the more common secondary amyloidosis in (i) the absence of specific etiological factors as tuberculosis or chronic suppuration (ii) minimal involvement of organs commonly affected by secondary amyloidosis (e.g. liver, spleen, kidney and adrenals). (iii) maximum deposit of amyloid in such sites as heart, blood vessels, skin and skeletal muscles which are not usually involved in secondary amyloidosis (iv) failure of amyloid deposit to show the usual staining reactions with specific amyloid stains, and (v) the occasional occurrence of amyloid tumours.
To date, some 90 cases of primary systemic amyloidosis have been reported in the literature and of these very few showed an involvement of conjunctiva. The present case is interesting not only for its situation but because it is a primary affection of the conjunctiva by amyloid degeneration taking the form of a tumour mass. Tumour forming amyloidosis is characterised by the appearance of a small single or multiple tumours in the eye, bladder, pharynx, tongue, urethra or the respiratory tract. It is usually of primary type.
| Summary|| |
An interesting and rare case of tumour forming amyloidosis of the conjunctiva, primary type, is described. Primary and secondary types are differentiated. A brief review of the literature is given.
| References|| |
Bernes, C. ( 1936) The eye and its diseases, p. 413, W. B. Saunders Company, Philadelphia.
Duke-Elder, W. S. ( 1938) Text Book of Ophthalmology, V. 2, pp. 1438-1440, 1750-1751, Henry Kimpton, London.
de Schweinitz, G. E. ( 1921 ). Diseases of the eye Ed. 9, p. 248, W. B. Saunders Company, Philadelphia.
Elles, N. B. ( 1945) Amer. Jour. Ophthal. 28, 5.
Fuchs, E. ( 1919). Text Book of Ophthalmology, Ed. 6, pp. 207-208, J. B. Lippincott Company, Philadelphia.
Lubarsch. O. ( 1929 ). Virchows, Arch. Path. Ant. 271, 867.
Ophthalmic Pathology ( 1952) - Atlas & Text Book. W. B. Saunders (Lond. ).
Redi, F. ( 1948 ). Gior. Ital. Oftal. 1, 227-263. Quoted in Ophthalmic literature, 1948.
Srinivasan, E. C. ( 1949) Proc. All-India. Ophthalh. Soc. 10,
Treacher Collins, E. and Mayou, M. S. ( 1925 ). Pathology and Bacteriology of the Eye Ed. 2 pp. 675, 708. P. Blakiston's Son & Company, Philadelphia.
Wiener, M. ( 1946) Ophthalmology in the war years, p. 246. The year book publishers, Chicago.
Wolff, E. ( 1935 ). A Pathology of the eye, p. 33, P. Blakiston's Son & Company, Philadelphia.
[Figure - 1]