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JAMA Ophthalmology Clinical Challenge
April 23, 2020

Slowly Progressive Unilateral Blepharoptosis in a 37-Year-Old Woman

Author Affiliations
  • 1Massachusetts Eye and Ear, Harvard Medical School, Boston
  • 2Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Harvard Medical School, Boston
  • 3David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Harvard Medical School, Boston
JAMA Ophthalmol. Published online April 23, 2020. doi:10.1001/jamaophthalmol.2020.0460

A healthy 37-year-old woman presented for evaluation of left upper eyelid blepharoptosis that had been slowly worsening for several years. The patient was otherwise asymptomatic, and a complete review of systems was negative. The results of her physical examination were notable for left-sided blepharoptosis with a palpable mass of the upper eyelid laterally. Eyelid eversion examination findings showed a yellow nodular lesion along the tarsal conjunctiva (Figure, A). An incisional biopsy was performed. Histopathologic examination results showed amorphous acellular proteinaceous deposits that positively stained with Congo red (Figure, B, inset). Polarized microscopy of the deposits showed apple-green birefringence (Figure, B).

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