gms | German Medical Science

Due to the mild course of a subconjunctival haemorrhage, only information of the patients about the harmless nature of this common phenomenon is often neccessary. Exclusion of inflammation, traumatic or valsalva events in history and general coagulation disorders is essential in differential diagnostics.

A 54-year-old patient presented with subconjunctival haemorrhage of his left eye. He reported about similar trouble in the path. Lab examinations of coagulation parameters and investigations in cardiovascular risk factors did not reveal an abnormal finding. Slit lamp examination showed yellow discoloration of the bulbar conjunctiva. Additional application of tear lubricants was recommended. When the patient had a recurrent bleeding, biopsy of a conjunctival specimen was undertaken - in respect to the strictly unilateral appearance.

During the excision of the sample, a massive bleeding took place. The small wound enlarged to several millimetres and has to be readapted by suture. Histological examination showed a partly homogenous and perivasal frill-like hyalinosis besides fresh blood deposits. The amorphic material had positive kongo red expression and birefringence. The immunhistochemical classification of amyloid revealed the presence of monoclonal AL-lamba light chain deposition. Exclusion of generalized secondary amyloidosis is crucial due to the life-threatening nature of the disease. Otherwise, high dose chemotherapy with following autologous bone marrow transplantation is the necessary treatment at the moment.

Monoclonal gammopathy can result in high vascular fragility by conjunctival amyloid deposition. Biopsy of the conjunctiva should be regarded in cases of otherwise unknown origin in recurrent subconjunctival bleedings.