Bilateral Diffuse Conjunctival Lesion In A Case Of Multiple Myeloma

Importance of thorough clinical evaluation when a patient presents with bilateral diffuse conjunctival lesion.

Cornea clinic services in tertiary eye centre

A 52-year-old female presented  with complaints of diffuse swelling in both the eyes. On examination she has Best corrected visual acuity (BCVA) of 6/6 with diffuse elevated boggy appearance of conjunctiva, petechial lesions are also observed. Rest of the anterior segment and fundus was within normal limit.She gave systemic history of Multiple myeloma and she was on treatment. Anterior segment optical coherence tomography (ASOCT) was done through the lesion where it showed hyperreflective wave like deposits. On Confocal microscopy there are hyperreflective deposits correlating with ASOCT picture. Incisional biopsy was done and sent for histopathology where it came out to be lambda and kappa protein depositions suggesting of Amyloidosis.

Based on clinical examination, systemic history and investigations diagnosed as conjunctival amyloidosis.She sent for evaluation and biopsy from neck mass also revealed amyloid deposits and started on therapy where systemic amyloidosis was not diagnosed earlier.

Always a thorough clinical evaluation with detailed systemic history, is crucial for accurate diagnosis and timely referral of the patient to prevent further complications.