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ARTICLE
Year : 1962  |  Volume : 10  |  Issue : 1  |  Page : 16-18

Amyloid degeneration of the bulbar conjunctiva


Medical College, Jabalpur, India

Date of Web Publication18-Mar-2008

Correspondence Address:
R K Mishra
Medical College, Jabalpur
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Mishra R K. Amyloid degeneration of the bulbar conjunctiva. Indian J Ophthalmol 1962;10:16-8

How to cite this URL:
Mishra R K. Amyloid degeneration of the bulbar conjunctiva. Indian J Ophthalmol [serial online] 1962 [cited 2020 Nov 28];10:16-8. Available from: https://www.ijo.in/text.asp?1962/10/1/16/39568

Primary degeneration of the conjunctiva of amyloid nature is a rare but well established condition. It was first reported by Oetting in (1871). Independent studies have been contributed by Ellis 1945, Redi 1948, Ashton 1951, Handousa 1952, Oppel 1956. A few reports have also appeared from India­(Shrinivasan 1949, Wahi & Wahi 1954, Agrawal 1958, Mathur and Mathur 1959, Samee Hamid and Kailashnath 1960).

Amyloid degeneration of the conjunctiva has been described in two groups by Lubarsch (1929), i) Primary, ii) Secondary. The features of the primary type being the absence of antecedent or co-exist­ant disease, involvement of meso­dermal tissues and variability of the staining reaction. Those of the secondary type are:-tendency for nodular deposition, consistency in staining reaction of the amyloid material and involvement of the organs like spleen, kidney and liver. Koletsky and Stretcher (1936) and King (1948) stressed that the two forms frequently showed over­lapping of chief features. In most of the cases reported amyloid de­generation followed some chronic inflammation like trachoma. (Redi and Chinaglia 1952, Oppel 1956, Agrawal 1958, Mathur & Mathur 1959, Sami Hamid and Kailashnath 1960). Oppel is of the view that trachoma is present in 60% to 70% of such cases. In all these reported cases bulbar conjunctiva seems to have been unaffected.

The present case is reported for the following features-i) Bulbar conjunctival involvement, ii) Re­current bleeding-as the main symptom, iii) A definite history of trauma preceeding the eye trouble.

Case report:­

A young man, K. L., age 30 years, came to the Eye Out-Patient Depart­ment of Medical College Jabalpur on 11th Jan. 1961, with a complaint of recurrent bleeding from the right eye. He gave a history of a blunt injury to the right eye in March 1956, for which he was treated for three months. In April 1957, the same eye became red for no obvious reason. He was treated again for a month with complete relief. Thereafter the eye continued to be red of and on. The patient neglected it as there was no pain, no tenderness and no effect on vision. He consulted us only when there was frank bleeding from the right eye.

Examination of the right eye showed the following features [Figure - 1],[Figure - 2]. Lids were normal, the bulbar conjunctiva in the interpalpebral area was swollen, succulent, and granular on the temporal side. The nasal part of the bulbar conjunctiva was raised into a small waxy mass. The for­nices end the palpebral conjunctiva were normal. Vision of right eye was 6/9 and the fundus showed no abnormality. The raised bleeding area on the temporal side was not tender but was extremely friable. It broke on being caught by a pair of forceps. The sclera showed no evidence of ulceration. No foreign­ body was located in neighbour­hood. The left eye was found to be normal. Vision 6/6. There was no evidence of trachoma in either eye. The kidneys, lungs, liver and cardiovascular system showed no abnormality. The case was clinic­ally labelled as-Chronic granu­loma.

Laboratory investigation:

The total and differential leuco­cytic count, Hemoglobin %, Erythrocyte sedimentation rate, serum protein and serum cholestrol were normal. Serological tests for syphilis were negative. Urine examination showed no abnormal­ity and the Bence Jones proteins were normal.

Screen chest, X-Ray of the long and flat bones showed no abnor­mality.

Histological examination:

A piece of ½ c.m. x ½ c.m. of the bulbar conjunctiva from the tem­poral mass was removed. The tissues showed amyloid degenera­tion on histological examination [Figure - 3].

Comments:­

The aetiology of amyloid de­generation in ocular tissues is unknown. Trachoma is said to be an important cause. In 1945 Ellis suggested nutritional deficiency as a possible cause. Duke-Elder (1938) and Ashton (1957) considered amy­loid degeneration as a sub-group of hyaline infiltration. Wahi & Wahi found no cause in their case. In the present case there was no evidence of amyloid disease else­where in the body. There was no trachoma. In the absence of any other cause trauma is the only suspicious factor.

The case was treated with Vita­min C. 500 mg. intramuscular, ten injections, followed by 250 mg. oral, thrice a day for 15 days. Locally liq. Adrenelin 1 : 100 was instilled thrice a day for two days.

The bleeding had stopped in 48 hours, but application of eye spe­culum one day later for a photo­graph caused fresh sub-conjuncti­val haemorrhage. Vitamin C. was repeated with prompt results. Thereafter the eye has been quiet without bleeding or redness.[13]


  Summary Top


A case of primary amyloid de­generation of conjunctiva is report­ed with unique features of bulbar involvement associated with re­current bleeding. The relevant literature has been reviewed.

 
  References Top

1.
Agrarwal, S, and Shrivastava, (1958), Brit. J. Ophth. 42, 433.  Back to cited text no. 1
    
2.
Ashton N. and Ray A, (1947), Brit. J. Ophthal. 35, 125.­  Back to cited text no. 2
    
3.
Ellis, N. (1945), A. Al. J. Ophth. 28, 486.  Back to cited text no. 3
    
4.
Koletsky, S. & Stretcher, R. M., (1939), Arch. Path., Chicago, 27, 267­  Back to cited text no. 4
    
5.
King, L., (1948), Amer. J. Path. 34, 1095.  Back to cited text no. 5
    
6.
Lubarsch, O, (1929), Virchow, Arch. Patj. Anat., 271, 861.  Back to cited text no. 6
    
7.
Mathur, S.P. and Mathur B. P.. (1950), Brit. J. Ophth. 43, 755.  Back to cited text no. 7
    
8.
Oetting Von., (1871 ), Dorpat. Med. Z., 2, 49.  Back to cited text no. 8
    
9.
Oppel, O., (1956), Klin. M. Augenheik, 128, 14­  Back to cited text no. 9
    
10.
Redi F., (1948), Gior, Ital. Ophtal, Florence, 1, 227-264.  Back to cited text no. 10
    
11.
Sami Hamid and Kailashnath, (1960), Amer. J. Ophth., 49, 814.  Back to cited text no. 11
    
12.
Shrinivasan, E. C. (1949), Proc. All-India Ophth. Soc., 10, 39.  Back to cited text no. 12
    
13.
Wahi P. N., Wahi P. N. mind Mathur K. N., (1954), J. All-India Ophthalmic Society, 2, .45-47.  Back to cited text no. 13
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]



 

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