Conjunctival Deposits

These can occur in both the conjunctiva and cornea. Some, like some tumors, lead to pigmented changes in the conjunctiva. However, their typical appearance usually readily distinguishes them from tumors (Fig. 4.24). The following conjunctival and corneal deposits and discolorations may occur:

Adrenochrome deposit (Fig.4.24h). Prolonged use of epinephrine eyedrops (as in glaucoma therapy) produces brownish pigmented changes in the inferior conjunctival fornix and on the cornea as a result of epinephrine oxidation products (adrenochrome). This can simulate a melanocytic conjunctival tumor. Therefore, the physician should always ascertain whether the patient has a history of prolonged use of epinephrine eyedrops. No therapy is indicated.

Iron deposits (Fig.4.24i). In women, iron deposits from eye make-up and mascara are frequently seen to accumulate in the conjunctival sac. No therapy is indicated.

Argyrosis. Prolonged used of silver-containing eyedrops can produce brownish black silver deposits in the conjunctiva.

Ochronosis (alkaptonuria: an inherited autosomal recessive deficiency of the enzyme homogentisate 1,2-dioxygenase). Approximately 70% of all patients with ochronosis exhibit brownish pigmented deposits in the skin of the eyelids, conjunctiva, sclera, and limbus of the cornea (Fig.4.24j). The deposits increase with time. The disorder cannot be treated in the eye.

Metallic foreign bodies in the conjunctiva. A metallic foreign body that is not removed immediately will heal into the conjunctiva, where it will simulate a pigmented change in the conjunctiva (Fig. 4.24g). Obtaining a meticulous history (the examiner should always enquire about ocular trauma) will quickly reveal the cause of the anomaly. The foreign body can be removed under topical anesthesia.

Jaundice. This will lead to yellowing of the conjunctiva and sclera.

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