Vol 130, No 8, August 2012

Archives Clinical Challenge: You Make the Diagnosis

Subconjunctival Nodules in a 38-Year-Old Woman

REPORT OF A CASE

A 38-year-old woman had ocular irritation and foreign body sensation in both eyes for 2 weeks. Slitlamp examination revealed a white and quiet conjunctiva with multiple yellowish subconjunctival nodules (0.5-2 mm) without feeder vessels in the superior bulbar conjunctiva (Figure). Six months prior to her initial visit, she began having attacks of asthma, recurrent sinusitis, episodes of upper gastric pain, and skin rash. She was found to have granulomas of the lung tissue associated with tissue eosinophilia, peripheral eosinophilia, increased total IgE level, and positive findings for perinuclear antineutrophil cytoplasmic antibodies.

What is your diagnosis?

Figure.
Yellowish nodular lesions in the bulbar conjunctiva of the right eye.

Please e-mail your diagnosis to ophthquiz@jamanetwork.org. You must include your full name, mailing address, and institutional affiliation in the initial e-mail to be eligible to enter the quiz. The first correct respondent will be recognized in the print journal and on our website and will receive a 1-year complimentary online subscription to Archives of Ophthalmology. Because of the volume of responses we are able to respond to the first person with the correct answer only.

For a complete presentation of this case and an in-depth discussion of the entity, please see next month's edition of the Archives.

Congratulations to the winner of our July quiz, Sreedhar B. Jyothi, DO, MRCOphth, Department of Ophthalmology, York District Hospital, York, England.

The correct answer to our July challenge was silicone oil granuloma.

For a complete discussion of this case, see the Research Letters section in the August Archives (Couch SM, Harocopos GJ, Holds JB. Orbital silicone oil granuloma discovered during enucleation. Arch Ophthalmol. 2012;130[8]:1083-1085).

Next month's quiz will be available on September 10, 2012, at 3pm Central time.