Amyloidosis of the orbit and adnexae

Five patients representing a spectrum of orbital and adnexal amyloidosis are presented. One patient with conjunctival amyloidosis did not have antecedent infection nor systemic disease (primary localized amyloidosis), while another patient with conjunctival amyloidosis had a long history of repeated attacks of bacterial conjunctivitis (secondary localized amyloidosis). The third patient presented with serial bilateral lacrimal gland amyloid without systemic disease (primary localized orbital amyloidosis). Another patient had intraorbital amyloid associated with metastatic deposits or immunoglobulin-producing lymphoma cells in the orbit (secondary systemic amyloidosis) and a fifth patient, with borderline Congo red staining for amyloid, was shown by electron microscopy to have macrophages with intracellular amyloid-like fibrils and extracellular crystalline material resembling immunoglobulin deposits. Amyloidosis has been clearly shown to be associated with immunoglobulins and plasma cells. Electron microscopic findings in our two cases of primary localized orbital amyloidosis leave unresolved the suggestion that mesenchymal cells, in addition to plasma cells, may be responsible for the production of amyloid. It should be emphasized for the clinician that amyloidosis of the conjunctiva and orbit is almost always a benign disease without systemic implications. On the other hand, amyloid of the skin of the eyelids, is a hallmark of generalized amyloidosis.