Purpose

To report a rare case of conjunctival amyloidosis in an Asian patient, emphasizing the importance of thorough history taking and meticulous examination to aid disease recognition and appropriate management of functional eyelid abnormalities.

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Methods

An elderly Chinese woman presented with a chronic history of bilateral upper eyelid droop with discomfort and redness of her right lower eyelid. She had previously sought consult at a different hospital a decade prior with a provisional diagnosis of an infiltrative lesion considered. However, she defaulted follow-up. She presented to our institution with progressive bilateral upper eyelid fullness causing ptosis and right lower eyelid cicatricial entropion associated with lash-corneal touch, multiple palpebral and forniceal conjunctival follicles, and a lumpy appearance of her tarsal plate. The rest of her ocular examination was unremarkable, with no periorbital masses or cervical lymphadenopathy.

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Results

Given the clinical history with unusual and asymmetric eyelid involvement, she underwent bilateral upper and lower eyelid conjunctival biopsies to exclude sinister pathologies. Histopathology showed chronic lymphocytic and plasmocytic inflammation that stained positive with Congo Red, consistent with amyloid deposition. Flow cytometry was negative for lymphoproliferative disease. A systemic work-up excluded multi-organ involvement. She opted for right lower lid cicatricial entropion repair via tarsal fracture and lateral tarsal strip with debulking of her right lower lid, achieving good functional outcome.

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Conclusion

Amyloidosis is a rare disease that occurs when amyloid proteins accumulate in various organs. Even more rarely, peri-ocular, ocular and orbital tissues are involved. While slowly-progressive, its clinical appearance mandates the need to exclude more sinister pathologies. Histopathological diagnosis is crucial to guide treatment. Where symptomatic, conjunctival involvement with eyelid thickening and malposition is amenable to surgical debulking in combination with other eyelid surgery to optimize functional outcomes.

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Additional Authors

First name	Last name	Base Hospital / Institution
Lexley	Ong	Tan Tock Seng Hospital / National Healthcare Group Eye Institute (Singapore)
Angelica Rose	Wong	Tan Tock Seng Hospital / National Healthcare Group Eye Institute (Singapore)

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