of amyloid remains to be determined, however, and, in fact, there is reason for believing that amyloid deposits vary in composition sufficiently to form a spectrum from typical amyloid to nonspecific hyalin. The term "paramyloid" has been introduced to designate hyaline deposits that give atypical or inconsistent staining reactions for amyloid. Several recent publications^1-6have reviewed the various concepts of the nature and pathogenesis of amyloidosis, but the clinicopathologic classification offered by Reimann and co-workers⁷30 years ago continues to enjoy general acceptance: Primary amyloidosis, in which there is no known predisposing disease, characterized1f:T442,

To the Editor.

—Orbital amyloidosis may be localized to the orbit alone (primary localized orbital amyloidosis) or may be associated with eyelid involvement and systemic amyloidosis.^1,2Primary localized orbital amyloidosis is uncommon, especially if it is isolated to the extraocular muscles.²This report describes an unusual case of primary localized orbital amyloidosis localized solely to the extraocular muscles, resulting in proptosis and restricted ocular motility. Enlarged extraocular muscles were shown on computed tomography, and massive infiltration by amyloid was documented histopathologically.

Report of a Case.

—A 28-year-old woman was referred to the Mayo Clinic, Rochester, Minn, for evaluation of progressive right proptosis and horizontal diplopia of 1-year's duration. Her medical history was otherwise normal and she specifically denied a history or symptoms of thyroid disease. Visual acuity was 20/20 OU. A 30-diopter right-sided exotropia was present with complete inability to abduct or adduct the eye. Forced ductions of20:T416,Ocular adnexal amyloidosis is characterized by amyloid deposition within the deep connective tissue layers of the eyelids, conjunctiva, and anterior orbit. Management of advanced cases has traditionally been unsatisfactory, with either no surgery offered because of fear of hemorrhage or an en bloc resection performed of the entire involved area. We present two cases of advanced periorbital amyloidosis successfully managed by preserving the anatomic planes of the eyelids and meticulously debulking the deposits with a spooned curette. Lax eyelid tendons and aponeuroses were simultaneously repaired, and no sacrifice of eyelid tissues was necessary. One patient remained asymptomatic for 2 years after surgery before developing early reaccumulation in the lower eyelids. The other patient required additional eyelid debulking and ptosis revision 8 months after surgery, but was in stable condition at follow-up 2 years after surgery. This technique offers safe, easily repeatable, nondestructive treatment for advanced periocular amyloidosis.

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