Primary Localized Conjunctival Amyloidosis

A patient with a few years of intermittent left eye redness and left eyelid drooping. He has no significant past ocular or past medical history. Exam reveals intact visual acuity, normal pupils, intraocular pressure, extraocular motility, and confrontational visual fields. The slit lamp exam revealed mild left upper eyelid ptosis with multifocal yellow gelatinous lesions of both the bulbar and palpebral conjunctiva. There was also a small similar appearing lesion on the bulbar conjunctiva of the right eye. Anterior segment OCT demonstrated a heterogenous lesion with hyper-reflective curvilinear foci. Conjunctival biopsy revealed amorphous acellular deposits in the substantia propria, which stained with Congo Red and demonstrated apple green birefringence in polarized light. The diagnosis of conjunctival amyloidosis was made. A systemic work-up, which included cardiac, renal, and liver function tests as well as SPEP and UPEP, was negative. This confirmed the diagnosis as primary localized conjunctival amyloidosis. The patient did not wish to undergo surgical resection, therefore the lesions are being observed.

Presentation Date: 08/08/2024

Issue Date: 08/23/2024