Primary localized conjunctival amyloidosis simulating a lymphoproliferative disorder

A 39-year-old previously healthy woman presented with a 3-year history of a painless lump in her left upper eyelid that had been increasing in size over the last 8 months. On examination, a soft, nontender mass was palpated in the medial left upper eyelid and anterior orbit. She had 2 mm of eyelid ptosis and 2 mm of inferior globe displacement. A salmon-pink mass of tissue was identified in the superomedial conjunctiva. The remaining ophthalmic examination was unremarkable. A lymphoproliferative process was suspected; however, an incisional biopsy revealed amyloid. Further workup showed no evidence of systemic amyloidosis, lymphoma, plasmacytoma, or multiple myeloma. The patient has been followed for more than 16 months with no new developments in her health. Amyloidosis has a variety of presentations in the periocular region and may be the sole manifestation of the disease process. It is not often considered in the differential diagnosis of conjunctival lesions. The classic "salmon-pink" conjunctival infitrate has been associated with lymphoproliferative disorders; however, amyloid should also be considered, as it may be clinically indistinguishable.