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      AS-OCT in diffuse conjunctival lymphangiectasia

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      Indian Journal of Ophthalmology
      Wolters Kluwer - Medknow

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          Abstract

          Conjunctival chemosis is due to the presence of excess fluid in the conjunctival interstitium. It is caused by several conditions, including inflammation, allergy, infection, neoplasia, trauma, exposure, obstruction of lymphatic and venous outflow etc. This patient presented with unilateral diffuse non-resolving chemosis since one year. He had undergone extensive systemic investigations and imaging which were all negative and could not ascertain the cause of chemosis. An anterior segment optical coherence tomography (AS-OCT) confirmed the diagnosis as diffuse conjunctival lymphangiectasia. AS-OCT showed dilated lymphatic vessels as empty thin walled dark spaces of varying caliber in the sub-conjunctival space. Conjunctiva is elevated and thickened due to edema and the sclero-conjunctival interface can be visualized below. [Fig. 1] AS-OCT is a very useful non-invasive tool to confirm conjunctival lymphangiectasia.[1] Figure 1 External (a) and slit lamp photos (b and c) showing chemosis and AS-OCT images (d and e) showing dilated lymphatic channels and conjunctival edema. Inset in d and e shows location of scans Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

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          Evaluation of lymphatic vessel dilatations by anterior segment swept-source optical coherence tomography: case report

          Background Conjunctival lymphangiectasia is a rare condition presumably caused by the obstruction of lymphatic channels or by an abnormal connection between conjunctival lymphatic and blood vessels. Diagnosis is based on clinical appearance and histology. We report a case of conjunctival lymphangiectasia in which anterior segment optical coherence tomography (OCT) was used to assist the diagnosis and the planning of the biopsy location. Case presentation A 31-year-old woman was referred with repeated episodes of conjunctival “hemorrhages” and chemosis with extended recovery periods over the last months. Other symptoms were dryness, redness, burning sensation and itching. Photo documentation, anterior segment OCT, ultrasound, computer tomography (CT) and magnetic resonance imaging (MRI) of the brain were performed. MRI revealed dilated atypical Virchow-Robin space (VRS). Conjunctival biopsy was taken and the location of the biopsy was selected based on OCT findings. Based on the clinical appearance we suspected the case to be conjunctival lymphangiectasia or lymphangioma. Histology and immunhistochemistry confirmed the diagnosis of conjunctival lymphangiectasia. Conclusions Anterior segment OCT is a non-invasive tool, useful in the evaluation of conjunctival lesions and planning surgery.
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            Author and article information

            Journal
            Indian J Ophthalmol
            Indian J Ophthalmol
            IJO
            Indian Journal of Ophthalmology
            Wolters Kluwer - Medknow (India )
            0301-4738
            1998-3689
            August 2019
            : 67
            : 8
            : 1338
            Affiliations
            [1]Cornea and Ocular Surface, Gokhale Eye Hospital, Mumbai, Maharashtra, India
            Author notes
            Correspondence to: Dr. Nikhil S Gokhale, Cornea and Ocular Surface, Gokhale Eye Hospital, Anant Building, Gokhale Road South, Dadar West, Mumbai - 400 028, Maharashtra, India. E-mail: niksgokhale@ 123456gmail.com
            Article
            IJO-67-1338
            10.4103/ijo.IJO_2080_18
            6677058
            31332129
            85ef5660-ae55-408f-863f-b640929a66cd
            Copyright: © 2019 Indian Journal of Ophthalmology

            This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

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            Categories
            Ophthalmic Images

            Ophthalmology & Optometry
            Ophthalmology & Optometry

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