Tumors of the conjunctiva and cornea

Carol L Shields, Jerry A Shields, Carol L Shields, Jerry A Shields

Abstract

Tumors of the conjunctiva and cornea comprise a large and varied spectrum of conditions. These tumors are grouped into two major categories of congenital and acquired lesions. The acquired lesions are further subdivided based on origin of the mass into surface epithelial, melanocytic, vascular, fibrous, neural, histiocytic, myxoid, myogenic, lipomatous, lymphoid, leukemic, metastatic and secondary tumors. Melanocytic lesions include nevus, racial melanosis, primary acquired melanosis, melanoma, and other ocular surface conditions like ocular melanocytosis and secondary pigmentary deposition. The most frequent nonmelanocytic neoplastic lesions include squamous cell carcinoma and lymphoma, both of which have typical features appreciated on clinical examination. The caruncle displays a slightly different array of tumors compared to those elsewhere on the conjunctiva, as nevus and papilloma are most common, but oncocytoma and sebaceous gland hyperplasia, adenoma, and carcinoma can be found. In this report, we provide clinical description and illustration of the many conjunctival and corneal tumors and we discuss tumor management.

Keywords: Conjunctiva; cornea; melanoma; tumor.

Conflict of interest statement

None

Figures

Figure 1
Figure 1
Surgical excision of conjunctival malignancy using the “no touch” technique. (a) Absolute alcohol is applied by a cotton tip applicator to the involved cornea to allow for controlled corneal epitheliectomy. (b) The corneal epithelium is scrolled off using a controlled sweeping motion with a beaver blade. (c) The conjunctival incision is made approximately 4 mm outside the tumor margin. A beaver blade is used to create a thin lamella of tumor-free sclera underlying the limbal portion of the tumor. (d) The conjunctival malignancy is removed, along with tumor-free margins, including underlying sclera and limbal corneal epithelium. (e) Cryotherapy is applied to the conjunctiva at the site of resection. (f) Closure of the conjunctiva with absorbable sutures is performed
Figure 2
Figure 2
Epibulbar dermoid. (a) Limbal dermoid. (b) Central corneal dermoid
Figure 3
Figure 3
Dermolipoma in superotemporal conjunctival fornix
Figure 4
Figure 4
Epibulbar osseous choristoma on bulbar conjunctiva superotemporally, presenting as a firm, palpable mass
Figure 5
Figure 5
Epibulbar complex choristoma that was found histopathologically to have cartilage and ectopic lacrimal gland
Figure 6
Figure 6
Recurrent conjunctival papilloma in a child. (a) The fibrovascular mass caused bloody tears. (b) Following 3 months of oral cimetidine, the mass resolved
Figure 7
Figure 7
Hereditary benign intraepithelial dyskeratosis in a young woman who was a descendent of a Haliwa Indian. The opposite eye had a similar lesion
Figure 8
Figure 8
Epibulbar inclusion cyst with thick mucous from conjunctival glands
Figure 9
Figure 9
Conjunctival intraepithelial neoplasia (CIN; carcinoma-in-situ) with corneal involvement, displaying leukoplakia on both the conjunctiva and cornea
Figure 10
Figure 10
Invasive squamous cell carcinoma of the conjunctiva. (a) Gelatinous limbal squamous cell carcinoma. (b) Nodular squamous cell carcinoma. (c) Flat diffuse squamous cell carcinoma of the cornea
Figure 11
Figure 11
Conjunctival nevus. (a) Pigmented conjunctival nevus. (b) Nonpigmented conjunctival nevus
Figure 12
Figure 12
Racial melanosis found bilaterally in patient with dark skin complexion
Figure 13
Figure 13
Ocular melanocytosis with episcleral gray pigment, heavy uveal pigment, and little conjunctival pigment
Figure 14
Figure 14
Primary acquired melanosis of the conjunctiva, showing the characteristic irregular patchy flat pigmentation
Figure 15
Figure 15
Conjunctival melanoma. (a) Pigmented melanoma that arose de novo. (b) Pigmented melanoma that arose from primary acquired melanosis (left arrow). Note the flat extension of the melanoma into the cornea. (c) Nonpigmented melanoma, recurrent following previous excisions
Figure 16
Figure 16
Pyogenic granuloma
Figure 17
Figure 17
Capillary hemangioma of the conjunctiva in a newborn infant
Figure 18
Figure 18
Cavernous hemangioma of the conjunctiva in a young child
Figure 19
Figure 19
Lymphangioma of the conjunctiva
Figure 20
Figure 20
Kaposi's sarcoma of the conjunctiva with typical surrounding hemorrhage
Figure 21
Figure 21
Juvenile xanthogranuloma of the conjunctiva in a child
Figure 22
Figure 22
Herniated orbital fat
Figure 23
Figure 23
Conjunctival lymphoma. (a) Limbal tumor. (b) Forniceal tumor
Figure 24
Figure 24
Metastatic breast carcinoma to the conjunctiva
Figure 25
Figure 25
Caruncular tumors. (a) Papilloma of the caruncle. (b) Nevus of the caruncle. (c) Oncocytoma of the caruncle

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