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JAMA Ophthalmology Clinical Challenge
April 8, 2021

A Growing Conjunctival Lesion in an Otherwise Healthy Patient

Author Affiliations
  • 1Department of Ophthalmology, The Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
  • 2Department of Pathology, The Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
JAMA Ophthalmol. Published online April 8, 2021. doi:10.1001/jamaophthalmol.2020.4628

A 73-year-old man was referred to our service for assessment of a slow-growing conjunctival lesion in the left eye. He had first noticed left eye discomfort and a fullness of the left lower eyelid 3 months previously. He denied any vision or systemic symptoms. His ophthalmic history was noncontributory. The patient’s medical history was notable only for prostate carcinoma, which was treated with radiotherapy 12 years ago. On examination, his visual acuities were 20/25 OU. Slitlamp examination of the anterior segment revealed diffuse yellow-pink polypoidal papules affecting the inferior fornix and inferior palpebral conjunctiva of the left eye (Figure 1A). The upper palpebral conjunctiva in the left eye had a velvety yellow appearance (Figure 1B). The remainder of the examination of both eyes was unremarkable. Initial investigations, including a complete blood cell count, urinalysis, and measurement of inflammatory markers, kidney function, and prostate-specific antigen level, were within normal limits. Serum electrophoresis showed raised monoclonal IgM bands (7.25 g/L; reference range, 0.50-2.00 g/L) with a κ/λ light-chain ratio of 2.92 (reference range, 0.260-1.65).

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