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Ptosis from localized A-lambda-amyloid deposits in the levator palpebrae muscle
Stefan Dithmar1, Reinhold P Linke, Gerold Kolling
1Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. stefan_dithmar@med.uni-heidelberg.de
Purpose:
To describe a patient with unilateral ptosis caused by localized amyloid deposits of immunoglobulin lambda-light chains (A-lambda-amyloid) in the levator palpebrae muscle.
Study Design:
Case report and literature review.
Participant:
A 32-year-old otherwise healthy female with right-sided unilateral ptosis.
Methods:
The patient presented with right-sided unilateral ptosis without other ocular abnormalities. Palpebral fissures measured 5 mm on the right side and 8 mm on the left. Systemic evaluation, including neurologic and neuroradiologic examinations, was normal.
Results:
Several years after initial presentation, conjunctival amyloid deposits appeared. Ptosis surgery with resection of the levator muscle was performed, revealing massive deposits of A-lambda-amyloid in the excised tissue.
Conclusions:
Our patient had unilateral ptosis due to localized A-lambda-amyloid deposits in the levator muscle. No other amyloid deposits were initially found. Visible conjunctival deposits developed only years later. Ocular amyloidosis with isolated initial involvement of the levator muscle is a rare condition. Localized monoclonal gammopathy may have been the cause of this unique presentation.