Lymphangiectasia hemorrhagica conjunctivae: a brief description with an exemplary photograph
October 17, 2005
Contributed by: Caccamise Sr,MD
Not infrequently we see in the scleral conjunctiva small bright vesicles, arranged in a row like a string of pearls, or even joined so as to form longer sausage-like swellings. Here we have to do with dilated lymph-vessels that are filled with a clear liquid ( lymphangiectasiae ). These occur both in inflammation of the conjunctiva and also when the conjunctiva is perfectly healthy. “ from Fuchs’s Textbook of Ophthalmology by Duane: p. 222, 6th edition, 1919, Lippincott. The author was unable to find any mention of lymphangiectasia hemorrhagica conjunctivae in this classic Textbook of Ophthalmolgy. Incidentally, this single-volume classic of ophthalmology literature should be read from cover to cover by all ophthalmologists. Its clinical pearls are endless - many of them are applicable even now. Additionally, its style makes for enjoyable reading.
The author’s search of Thiel’s Atlas der Augenkrankheiten - 6th edition - failed to reveal mention of lymphangiectasia of the bulbar conjunctiva. Although the original edition of this arguably foremost hard-print eye atlas is in German, there is a two volume translation in English that should be available to all ophthalmologists - either in a personal library or in a medical school library.
I. Abnormal diffuse enlargement of lymphatics appears clinically as chemosis. Localized, dilated lymphatics appear clinically as a cyst or series of cysts, the latter commonly in the area of the interpalpebral fissure.
II. With diffuse involvement the cause generally is not known.
III. In the localized variety the dilated lymphatics generally are obstructed secondarily by an old scar, a pinguecula or some other conjunctival pathology. IV. Histologically the lymphatic vessels are dilated abnormally.
Lymphangiectasia hemorrhagica conjunctivae: I. The condition is characterized by a connection between a blood vessel and a lymphatic so that the latter is permanently or intermittently filled with blood. II. The cause is not known. “ from Yanoff and Fine: Ocular Pathology, pages 236 - 237, 1975, Harper & Row. According to Rieger in Velhagen’s Der Augenarzt, Volume III, p. 300 and table IX, fig. 81, 1960 (in German ), lymphangiectasia hemorrhagica conjunctivae was first described by Th. Leber in 1880 in Graefes Arch. Ophth. 26 III, 197 (1880) under the title: Klinisch-ophthalmologische Miszellen ( Clinical-Ophthalmological Miscellany ). Similar credit to Leber is given by F. Schieck in Kurzes Handbuch der Ophthalmologie, Volume IV, pages 8 and 10, 1931. Schieck points out that the lesion may be either lasting or evanescent. The latter applied to the author's case.
Department of Ophthalmology, St Bartholomew's Hospital, London, UK.
To re-describe a condition that has not been mentioned in the literature for more than four decades and to outline a new method of treatment of the pathology using an argon laser.
Nine patients were identified over a 2 year period who fitted a clinical picture consistent with the features of lymphangiectasia haemorrhagica. Three were treated for frequent recurrent haemorrhages with a newly developed technique using the argon laser and followed for up to 2 years.
None of the three treated patients has had a recurrence of the condition to date. In the six untreated patients the condition resolved spontaneously after repeated attacks over between 8 months and 8 years.
Lymphangiectasia haemorrhagica conjunctivae is probably more common than expected and may resolve spontaneously, but is readily amenable to treatment with the argon laser if attacks become frequent, uncomfortable or unsightly.
PMID: 9850253 [PubMed - indexed for MEDLINE]