Quiz: Epiphora, Itching & Crusting

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A 73-year-old African-American male presents with complaint of epiphora in both eyes.  He also reports itching and crusting for the last year after his cataract surgery. Despite using artificial tears 3-4x/day (minimal relief) and an oculoplastics evaluation for his lower lid ectropion, he remains symptomatic. His past ocular history is significant for hypertensive retinopathy, proliferative diabetic retinopathy/macular edema status post bilateral retinal laser and bilateral pars plana vitrectomy + CE/IOL. The remainder of his medical history is negative except hyperlipidemia and treated prostrate cancer.

Corrected visual acuity is 20/30 right, 20/40 left. Intraocular pressure measurements, confrontation visual fields, and ocular motility are all normal. He has mild bilateral upper lid dermatochalasis and left lower lid ectropion with punctal eversion. A small superonasal bulbar conjunctival lesion is noted bilaterally as well as a left lower lid palpebral lesion shown below. Dilated fundus examination was normal in both eyes.

Last Updated: October 31, 2022

1 thought on “Quiz: Epiphora, Itching & Crusting”

  1. With a presentation of bilateral conjunctival lesions, I respectfully believe it’s premature to diagnose localized amyloidisis without checking serology and ruling out systemic amyloidosis. I would prefer to see the final question worded in a less dogmatic way, even though I understand intent of the question. Good refresher…thanks for the case!


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