Conjunctival Lesion in a Patient With Ocular Graft-vs-Host Disease

Abstract

A 67-year-old man presented with intermittent ocular irritation, discharge, and blurry vision in his left eye. He had a history of chronic lymphocytic leukemia for which he had received allogeneic bone marrow transplantation; his course was complicated by extensive graft-vs-host disease including ocular manifestations. His graft-vs-host disease was treated with systemic tacrolimus. He also had a history of herpes simplex keratitis with fungal infection in the right eye that led to corneal perforation requiring penetrating keratoplasty. His best-corrected visual acuities were 20/125 OD and 20/60 OS.Slitlamp examination of the right eye revealed eyelid margin hyperemia, penetrating keratoplasty graft in place, a deep and quiet anterior chamber, a normal iris, and posterior chamber intraocular lens. Examination of the left eye revealed eyelid margin hyperemia, an apparent soft tissue lesion on the palpebral conjunctiva of the left lower eyelid, inferior bulbar conjunctival injection, a small paracentral anterior stromal scar, a deep and quiet anterior chamber, a normal iris, and posterior chamber intraocular lens. The conjunctival lesion had vascular and papilliform elements (Figure ) and had not been noted on a routine examination 6 months prior. Figure. Clinical photograph showing a soft-tissue lesion on the palpebral conjunctiva of the left lower eyelid, accompanied by inferior bulbar conjunctival injection. WHAT WOULD YOU DO NEXT? A. Perform time-domain anterior segment optical coherence tomography B. Observe the patient C. Perform a biopsy of the lesion D. Obtain a culture of the lesion Clinical Review & Education