Eyelids and anterior segment: Case twelve
This 24 year-old male hair dresser was referred by his family doctor because of this ocular appearance. It was initially diagnosed as a subconjunctival haemorrhage but failed to resolve over the past four weeks.
a. What does the picture show?There are dark reddish lesions found mainly on the inferior bulbar and palpebral conjunctiva. The lesions resemble subconjunctival haemorrhage.
In patient at risk for AIDS, a "non-resolving subconjunctival haemorrhage" should raise the possibility of Kaposi's sarcoma. This patient was found to be HIV positive on subsequent blood tests.
b. What types of patients are at risk of this condition?Kaposi's sarcoma is a rare mucocutaneous carcinoma before the emergence of AIDS. Amongst the AIDS sufferers, KS is found mainly in patients who acquired the HIV virus through homosexual contact. It is estimated that 25% of homosexual man with HIV virus will eventually develop KS during the course of their illness (cf. with <3% of heterosexual intravenous drug users with HIV virus.
c. What is the pathogenesis of this condition?The exact cause is unknown. The fact that it is found more commonly amongst homosexual males suggest the possibility of an infective agents. Recently, human papillomavirus (HPV)-16 DNA sequences have been found in some KS biopsy specimens suggesting it may play a part in the pathogenesis.
c. How would you manage this patient?
Kaposi's sarcoma is a slow-growing and rarely invasive lesion. Treatment is only needed if the patient finds it cosmetically unacceptable or if there were ocular discomfort.
There are several treatment options:
- radiation therapy
- intralesional vinblastine
Click here for the questions Click here for the main page Click here for FRCOphth/MRCOphth