A Rare Case of Amyloidosis of the Eyelid and Conjunctiva

Lipoid Proteinosis Masquerading as Seborrheic Dermatitis

We report a case of lipoid proteinosis (LP) masquerading as seborrheic dermatitis. A 35-year-old female presented to our outpatient department with complaints of itching and crust-like formation on eyelids for five years. She was treated as a case of seborrheic dermatitis elsewhere and got intermittent relief in itching with medications. Beaded lesions were found along the upper and lower eyelids involving the lash line and caruncle on removing the crust. The verrucous lesions were pathognomonic, moniliform blepharosis of LP. Systemic examination revealed hoarseness of voice, and hyperkeratosis was seen on the dorsum of both of her hands. She has been advised lid hygiene, artificial tears, and antihistaminics for itching. Skin emollients were also advised by dermatologists to decrease the chances of abrasion and bleeding from minor trauma. She was well explained about the danger signs as well as neurological and psychiatric implications of the disease. Although ophthalmologists have a rare encounter with this disease, LP is a well-known entity to dermatologists and otorhinolaryngologists, and thus it may sometimes go undiagnosed. An ophthalmologist should be well aware of the life-threatening complications associated with LP, and patients should be sensitized regarding the chronic nature, supportive measures, and danger signs of the disease.

Long-Term Follow-Up of 4 Patients with Conjunctival Amyloidosis

Conjunctival amyloidosis is a rare cause of ocular inflammation, mass, and hemorrhage that can be difficult to diagnose and treat. In this case series, we describe 4 patients with a histopathological diagnosis of conjunctival amyloidosis treated at a single institution. All patients underwent surgical excision and biopsy. On histopathological examination, 3 patients had local deposition of either kappa or lambda monoclonal immunoglobulin light chains, favoring localized amyloid light-chain amyloidosis. Systemic workup to exclude rheumatologic disorders (e.g., anti-neutrophil cytoplasmic antibody and rheumatoid factors) and hematological disorders (e.g., imaging, biopsies, and serum protein electrophoresis/urine protein electrophoresis) was negative except for a positive abdominal fat biopsy in 1 patient. Patients were followed for an average of 6.1 years (range 4 months to 15 years) with stable ocular disease.