Botryomycosis of limbal conjunctiva with Splendore-Hoeppli phenomenon

An 84-year-old man complained of irritation of the left eye of several months' duration. He had had several previous surgical procedures including removal of bilateral pterygia and bilateral cataract extraction. Examination of the bulbar conjunctiva on the left eye disclosed a collection of cilia (eyelashes) located adjacent to the limbus at the 11:30-o'clock position. This aggregate of cilia was associated with irregular yellowish deposits 1.5 mm in diameter. The cilia and redundant conjunctival tissues were surgically excised. Histopathologic examination showed a botryomycotic granule surrounded by a prominent acidophilic ring (Splendore-Hoeppli phenomenon). Gram stains demonstrated the presence of microcolonies of gram-positive cocci and gram-negative rods within the granule. We postulate that the entrapment of displaced cilia provided a nidus for the bacterial colonization forming the botryomycotic granule. To our knowledge, botryomycosis of the conjunctiva has not been reported previously.