Conjunctival AL amyloidosis as the initial manifestation of multiple myeloma

Conjunctival amyloidosis is an uncommon entity, generally primary and localized, that should be considered in the differential diagnosis of conjunctival lesions. We present the case of a 74-year-old man with no relevant medical history who, during follow-up after cataract surgery, developed elevated yellowish-salmon conjunctival plaques. Incisional biopsy revealed subepithelial amyloid deposits, positive for Congo red and immunohistochemistry consistent with AL amyloidosis with kappa light chain restriction. The initial systemic evaluation was normal; however, clinical progression led to the diagnosis of multiple myeloma with multisystemic involvement. Systemic treatment did not reduce the size of the conjunctival lesions, but topical cyclosporine improved ocular discomfort and the sensation of a foreign body. This case highlights the role of the ophthalmologist in the early detection of systemic diseases. Histological confirmation is essential, and although there is no specific treatment, symptomatic management and multidisciplinary follow-up improve the patient's quality of life.