|Year : 1962 | Volume
| Issue : 1 | Page : 16-18
Amyloid degeneration of the bulbar conjunctiva
Medical College, Jabalpur, India
|Date of Web Publication||18-Mar-2008|
R K Mishra
Medical College, Jabalpur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mishra R K. Amyloid degeneration of the bulbar conjunctiva. Indian J Ophthalmol 1962;10:16-8
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.
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.
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.
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].
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.
| Summary|| |
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|| |
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[Figure - 1], [Figure - 2], [Figure - 3]