Bilateral epibulbar rheumatoid nodulosis. A new ocular entity.

A 61-year-old woman, whose rheumatoid arthritis had been quiescent for 9 years, developed a crop fo 16 painless bilateral episcleral rheumatoid nodules without any flareup of her joint disease. Biopsy of the lesions disclosed lymphocytic and plasmacytic infiltration within the conjunctiva, overlying palisading granulomas with elongated epithelioid histiocytes, multinucleated giant cells, and central necrobiotic degeneration of the collagen of the episclera and superficial sclera. The rheumatologic designation for the development of groups of subcutaneous nodules in inactive rheumatoid arthritis is rheumatoid nodulosis. This report is the first description of this entity in the ocular adnexa.