Grand Rounds

A patient with past history of rosacea presents with 18 months of worsening left eye ptosis and ocular surface irritation. On presentation, the patient’s visual acuity was 20/40, and exam showed diffuse infiltration of an unknown salmon-colored, pink-yellow substance in the inferior bulbar and tarsal conjunctiva and inferior fornix of the left eye. Anterior segment optical coherence tomography showed normal-thin thickness epithelium with an underlying heterogenous, hyporeflective mass lesion with interspersed hyperreflective dots and lines. Incisional biopsy demonstrated Congo Red staining of a subepithelial infiltrative substance, apple-green birefringence under polarized light, and positivity for light chains. A diagnosis of conjunctival amyloidosis was made. Systemic work-up for systemic amyloidosis was performed and was normal. Three years later, on follow-up examination, the patient was experiencing increasing discomfort, and the decision was made to perform surgical debulking with multi-layered amniotic membrane grafting and symblepharon ring placement. The patient has since developed involvement of her right eye and continued gradual infiltration of her left eye. She has deferred further surgery for her ptosis, trichiasis, and ocular irritation, and continues to be monitored in the ocular surface tumors clinic.

Presentation Date: 10/29/2029
Issue Date: 10/30/2026