Eosinophilic, central necrotizing granuloma of the conjunctiva (Splendore-Hoeppli phenomenon). Clinical-histopathological study

Six patients with the clinical and histological findings of a so-called Splendore-Hoeppli phenomenon are described. The clinical picture is one of yellow, painless episcleral nodules with associated vascular injection; they are unilateral or bilateral, and isolated or multiple. Histologically, the granulomas are composed of a central eosinophilic material surrounded by epitheloid cells, giant cells and numerous eosinophils. The phenomenon is interpreted as an antigen-antibody precipitation as originally described in relation to parasites and fungi. Blood eosinophilia was seen in two patients. No parasitic or fungal agents were found in serial sections in this series and would not be detected on general examination. The diagnosis is established by histological examination. Topical corticosteroid therapy was ineffective. Excisional biopsy of the granuloma is the therapy of choice.