|Year : 1967 | Volume
| Issue : 6 | Page : 230-232
Bilateral lymphoid infiltration of the conjunctiva
K Nath, HV Nema, BR Shukla, AH Rahi
Muslim University Institute of Ophthalmology and Gandhi Eye Hospital, Aligarh, India
|Date of Web Publication||22-Jan-2008|
Muslim University Institute of Ophthalmology and Gandhi Eye Hospital, Aligarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nath K, Nema H V, Shukla B R, Rahi A H. Bilateral lymphoid infiltration of the conjunctiva. Indian J Ophthalmol 1967;15:230-2
Bilateral lymphoid infiltration of conjunctiva was first described by Valude and Morax (1902). Morax later conveyed in a personal communication to Mac Callan that he had seen only three cases. Mac Callan (1936) himself had seen only one case and concluded that the condition was extremely rare. Pascheff (1930) studied chronic hyperplasia of the conjunctiva histo-pathologically and classified them into five broad categories, lymphocytic hyperplasia being one. The present case is of clinical interest because the patient had post trachomatous bilateral lymphoid infiltration of the conjunctiva of such a high degree that it had practically covered the corneas of both the eyes.
| Case Report|| |
M.D., a female, aged 44 years was brought to the out patient department of the Gandhi Eye Hospital, Aligarh, on January 31, 1963, for redness, lacrimation, photophobia of both the eyes for six months and loss of vision in the right eye for 2 months and in the left eye for 15 days.
| Examination|| |
The patient was unable to open both eyes due to photophobia and oedema. The vision in both the eyes was perception of light only. The conjunctive showed acute trachoma III with marked papillary hypertrophy. Both eyes had yellowish red fleshy looking epibulbar masses extending roughly 4 mm all round the limbus and elevated 2-3 mm above the surface of the conjunctiva. They were soft, gelatinous, firmly adherent to the sclera and cornea and bled on touch. The growth covering the medial side of the left cornea was pink and nodular [Figure - 1],[Figure - 2].
The fornices of both the eyes were free from growth. There was no enlargement of the regional lymph nodes. General examination failed to reveal any systemic disease.
| Investigations|| |
Conjunctival smears from the eyes showed numerous polymorphonuclear cells with occasional lymphocytes. A few Gram-negative thin bacilli were seen in the smear from the left eye. Though no inclusions could be seen in the scrapings from both the eyes, the general cytology was characteristic of acute trachoma. The only significant laboratory investigation was that the total W.B.C. count was 15,900/ c.mm with 45% lymphocytes.
| Treatment|| |
The patient was given anti-trachoma treatment; this controlled the acute infection within a fortnight, but there was no regression of the growth in either eye. On February 17, 1963, excision of the growth in the left eye with partial superficial keratectomy was performed. Soon after the operation, the examination of the left eye revealed that nearly 2 mm peripheral portion of the cornea was vascularised, had deep corneal opacities and a few keratic precipitates. The pupil was constricted and had posterior synechix, but the patient could count fingers at a distance of 3 feet.
Histopathological examination, showed collection of round cells, plasma cells, polymorphs and occasional foreign body giant cells. There were a few newly formed blood vessels and some fibrous tissue. The overlying conjunctival epithelium was hypertrophied [Figure - 3]. The lesion was suggestive of a granulomatous tumour.
On March 6, 1963, excision of the growth in the right eye with superficial keratectomy was performed. The cornea thus uncovered was hazy through which could be seen a normal anterior chamber, a dilated and fixed pupil (atropinized) and an immature cataract. The patient could now count fingers from a distance of 2 feet.
The disc of the tissue removed from the right eye, on microscopical examination showed, circumscribed infiltration of lymphyocytes and lymphoblasts arranged in a follicular pattern as in lymph nodes [Figure - 4]. The lesion was consistent with lymphoid infiltration of the conjunctiva.
The patient was given a course of dexamethazone with long acting sulphonamides. Hot fomentations were applied and topically atropine drops 1%, Efcorlin drops 1 % and terramycin eye ointment were instilled post operatively. Some keratitis persisted in both the eyes. On March 17, 1963, a vascular nodule was noticed on inferonasal quardrant of the left limbus, 3.5 mm in diameter, firm in consistency and attached to the deeper tissues [Figure - 5]. The nodule remained stationary and did not invade the cornea, which had several diffuse opacities and vascularised supero-temporal and infero-nasal sectors. No recurrence was seen in the right eye [Figure - 6]. At this stage she could count fingers from 2 feet with the right eye and in the left eye her vision was 4/60. She was advised a course of X-ray therapy.
| Comments|| |
The interesting feature of the present case was the clinically similar but histopathologically different picture in the two eyes. This leads us to the question whether lymphoid infiltration and granuloma formation were the results of one and the same pathological condition or not.
In the present case trachoma probably caused a marked lymphoid reaction in the epibulbar region of the conjunctiva of both the eyes which subsequently covered the cornea completely. In the left eye, recurrent secondary bacterial infection probably provoked excessive neovascularization, which disturbed or masked the usual lymphoid collection and finally resulted in a granulomatous mass of the conjunctiva covering the major part of the cornea.
The recurrence in the right may perhaps be due to an incomplete dissection of the mass. There is no recognized treatment for lymphoid infiltration. Morax stated that the condition can be cured by applications of X'ray or radium.
| Summary|| |
A case of bilateral lymphoid infiltration of the conjunctiva covering the entire corneas of both the eyes is presented. The pathogenesis of this rare disease is discussed on the basis of the histological reports.
| References|| |
MAC CALLAN, A. F. (1936), Trachoma, Butterworth & Co., London, 63.
MORAX, cited by Mac Callan (1936).
PASCHEFF, C. (1930), Arch. d'Ophth., 47: 821.
VALUDE and MORAX (1902), Ann. D'Ocul., 190 cited by Mac Callan (1936).
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]