An unusual ocular manifestation of discoid lupus erythematosus
Robert E. Foster, MD
Careen Y. Lowder, MDAddress reprint requests to C.Y.L., Department of Ophthalmology, A31, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
David M. Meisler, MD
Rafael Valenzuela, MD
James T. McMahon, PhD
Charles Camisa, MD
Discoid lupus erythematosus is a chronic skin disease characterized by well-demarcated papules and plaques. Mucous membrane changes are common; however, conjunctival involvement is unusual. We report a case of unilateral, chronic, isolated discoid lupus erythematosus of the conjunctiva.OBSERVATIONS
A 32-year-old man presented for evaluation of chronic conjunctivitis of the right eye that had persisted for 9 years. A biopsy of the bulbar conjunctiva revealed a mixed mononuclear cellular infiltrate distributed along the epithelial basement membrane zone and around the stromal blood vessels. Immunohistopathologic examination revealed a diffuse, granular pattern of fluorescence corresponding to immunoglobulins and complement components along the epithelial basement membrane zone and in the walls of the stromal blood vessels. Electron microscopy demonstrated changes in the epithelial basal lamina consistent with discoid lupus erythematosus, including areas that were multilayered. Immunoelectron microscopy identified sub-basal lamina deposits of immunoglobulin G.CONCLUSIONS
Discoid lupus erythematosus should be a suspected cause of chronic conjunctival inflammation; the diagnosis is substantiated by immunopathologic and ultrastructural studies.