PMC6717973_01
Slit lamp photograph and high resolution anterior segment OCT of the patient's right eye. a A gelatinous, fleshy, firm, pink conjunctival lesion (asterisk) is present in the medial canthal area of the right eye and a pterygium-type lesion with a leukoplakic head encroaching on the cornea adjacent to it (arrow). b High resolution anterior segment OCT reveals a homogeneous hyporeflective lesion (asterisk) with thin overlying epithelium in the medial canthal area of the right eye. The inset indicates the level of the scan. c Slit lamp photograph of the right eye after 2 months of oral doxycycline 100 mg twice a day. The pterygium (arrow) remains unchanged while the nasal BRLH lesion (asterisk) has decreased in size and appears flatter and smaller. d High resolution anterior segment OCT confirms the reduced size of the nasal BRLH lesion (asterisk) after 2 months of oral doxycycline. The inset indicates the level of the scan
40662_2019_151_Fig1_HTML.jpg
PMC6717973_01_40662_2019_151_Fig1_HTML.jpg
Fig1
Upon examination of the right eye, a fleshy pink conjunctival lesion was noted in the medial canthal area (Fig. 1a). USA) of the bilateral medial canthal lesions revealed homogeneous hyporeflective lesions with thin overlying epithelium (Figs 1b, 2b). Upon further questioning the patient and his family, they reported the presence of the bilateral medial canthal lesions since the patient was a teenager, but the patient had never sought ophthalmic care. The medial canthal lesions continued to shrink as evidenced both on clinical exam (Figs. 1c, 2c) and high resolution anterior segment OCT (Figs. 1d, 2d).
Slit lamp photograph and high resolution anterior segment OCT of the patient's right eye. a A gelatinous, fleshy, firm, pink conjunctival lesion (asterisk) is seen in the medial canthal area of the left eye. b High resolution anterior segment OCT reveals a homogeneous hyporeflective lesion (asterisk) with thin overlying epithelium in the medial canthal area of the left eye. The inset indicates the level of the scan. c Slit lamp photograph of the left eye after 2 months of oral doxycycline 100 mg twice a day. Similar to the right eye, the nasal BRLH lesion (asterisk) has decreased in size and appears flatter and smaller. d High resolution anterior segment OCT confirms the reduced size of the nasal BRLH lesion (asterisk) after 2 months of oral doxycycline. The inset indicates the level of the scan
40662_2019_151_Fig2_HTML.jpg
PMC6717973_01_40662_2019_151_Fig2_HTML.jpg
Fig2
Examination of the left eye revealed a smaller fleshy pink conjunctival lesion in the medial canthus (Fig. 2a). USA) of the bilateral medial canthal lesions revealed homogeneous hyporeflective lesions with thin overlying epithelium (Figs 1b, 2b). Upon further questioning the patient and his family, they reported the presence of the bilateral medial canthal lesions since the patient was a teenager, but the patient had never sought ophthalmic care. The medial canthal lesions continued to shrink as evidenced both on clinical exam (Figs. 1c, 2c) and high resolution anterior segment OCT (Figs. 1d, 2d).
Histopathology of the incisional medical canthal biopsy specimen from the patient's right eye. a Hematoxylin-eosin staining of lymphoid follicles composed of small cells with mitotic figures and tingible body macrophages. (x 100 magnification) (b) Dense CD20 staining of B cells. (x 100 magnification) (c) CD3 staining of T cells within the follicles and in the interfollicular zones. (x 100 magnification)
40662_2019_151_Fig3_HTML.jpg
PMC6717973_01_40662_2019_151_Fig3_HTML.jpg
Fig3
Immunohistochemical staining was positive for CD20, CD3, Bcl-6, CD10 and Ki-67, and negative for Bcl-2 and Cyclin D1 (Fig. 3).