Elsevier

Survey of Ophthalmology

Volume 57, Issue 2, March–April 2012, Pages 136-148
Survey of Ophthalmology

Clinical Pathologic Reviews
Conjunctival Lymphangiectasia: A Report of 11 Cases and Review of Literature

https://doi.org/10.1016/j.survophthal.2011.08.001Get rights and content

Abstract

Conjunctival lymphangiectasia is an uncommon clinical condition in which there is dilatation of lymphatic channels in the bulbar conjunctiva. Conjunctival lymphangiectasia is a rarely appreciated ocular surface disorder that typically occurs as a secondary phenomenon in response to local lymphatic scarring or distal obstruction. Conjunctival lymphangiectasia can either be unilateral or bilateral with focal or diffuse bulbar chemosis. We present 11 cases of biopsy-proven conjunctival lymphangiectasia. Of the 11 cases, 3 presented with bilateral diffuse bulbar chemosis, 1 had diffuse unilateral chemosis, and the remaining 7 presented with focal (<90°) bulbar chemosis. Three of these cases had co-existing pterygium, and one case presented with focal bulbar chemosis and a conjunctival keratin horn. All underwent surgical excision of the involved conjunctiva, either with no graft (n = 6), combined with amniotic membrane transplant (n = 3), or combined with conjunctival autograft (n = 2).

Section snippets

Patients and Methods

We reviewed the computerized flies at the regional Ocular Pathology Laboratory based at the Western Infirmary, Glasgow, Scotland, between January 1995 and December 2010. We identified and reviewed 11 cases with the diagnosis of conjunctival lymphangiectasia. We compared our findings with those reported in the literature.

Results

The patient characteristics are summarized in Table 1.

Patient 1

A 59-year-old woman presented with a one-year history of ocular irritation associated with persistent bilateral conjunctival swelling. This immediately followed an upper respiratory tract infection with associated conjunctivitis and was presumed to be of viral etiology. She had been treated with topical lubricants and corticosteroids with little benefit. Visual acuity was 20/20 in each eye. Slit lamp biomicroscopy revealed diffuse chemosis affecting the inferotemporal conjunctiva (Fig. 1, Fig. 2

Histological Features

The lymphatic channels of the conjunctiva contain valves that allow for directed drainage towards the inner and outer canthi. Obstruction can occur in inflammatory and neoplastic disease. This obstruction leads to lymphangiectasia or, if extreme, lymphatic cysts. Excised tissue will show dilated channels lined by a flattened endothelium. The ultrastructural characteristics of ectatic lymphatic vessels do not differ significantly from a normal lymphatic vessel. The vessel is, however, dilated,

Discussion

The human lymphatic system, first described in 1627 by Gasper Aselli,30 functions to remove excess interstitial fluid and macromolecules from the extracellular space and transports this fluid through lymph nodes before returning it to the venous circulation.19 Despite its integral role in preserving tissue fluid homeostasis, the study of lymphatics remains at a rudimentary level when compared to blood vessels.101

Conjunctival interstitial tissue fluid enters through the initial lymphatic

Epithelial Inclusion Cyst

Conjunctival inclusion cysts are common, accounting for 22.5% of all acquired epithelial lesions, and 80% of all cystic lesions, of the conjunctiva.32 The incidence is equal between men and women, with an average age of onset of 47 years.32 They are classified as primary or secondary, depending on their etiology. The primary or congenital inclusion cyst is usually located to the superomedial portion of the orbit and develops during the embryonal period as the result of separation of a portion

Summary

Conjunctival lymphangiectasia has received scant attention in the medical literature, yet incidental sausage-like conjunctival cystic lesions are not infrequently seen during anterior segment examination. These require no intervention unless they result in persistent ocular surface irritation that is refractory to topical anti-inflammatories and lubrication. The vast majority are thought to represent secondary lymphangiectasia, developing as a consequence of a prior inciting stimulus, resulting

Method of Literature Search

A search of the PubMed database 1966–2010 was conducted using various combinations of the key words conjunctiva, lymphangiectasia, lymphangiectasis, lymphatics, chemosis, swelling, cyst, and hemorrhage. Articles in all languages were considered, provided that the non-English articles included English abstracts. Relevant articles that were cited in the reference lists of the retrieved articles were also included.

Disclosure

The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in this article.

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