Tumors of the ocular surface: A review

Abstract

Tumors of the Ocular Surface clinically manifest with a very wide spectrum and include several forms of epithelial, stromal, caruncular, and secondary tumors. As a group, these tumors are seen commonly in the clinical practice of a comprehensive ophthalmologist, cornea specialist, and an ocular oncologist. This review is aimed to discuss the common tumors of the ocular surface and emphasize on their clinical diagnosis and appropriate management.

Figure 1

Microphotograph of squamous papilloma (OM ×4). The lesion shows numerous vascularized papillary fronds lined by acanthotic epithelium

Figure 2

Conjunctival inclusion cyst, a smooth translucent lesion with turbid fluid

Figure 3

Pseudoepitheliomatous hyperplasia. Elevated leukoplakic pink lesion in the temporal limbal area with apparent feeder vessels and pigmentation. Note that it closely mimics a nodular ocular surface squamous neoplasia

Figure 4

Actinic keratosis, a focal leukoplakic lesion seen in the interpalpebral area. It can easily be misdiagnosed as pinguecula

Figure 5

Ocular surface squamous neoplasia. (a) Elevated nasal limbal mass involving the cornea with abundant keratin and feeder vessels. (b) Pigmented variant seen as a nodular mass. (c) Diffuse, elevated, papilliform lesion involving the entire ocular surface with intrinsic vessels. (d) Gelatinous type with episcleral feeder vessels with speckled rose bengal staining

Figure 6

Histopathology of ocular surface squamous neoplasia (OSSN). (a) Microphotograph of OSSN showing abnormal epithelial cells with mitotic activity (OM ×10). (b) Seen at higher magnification (OM ×40)

Figure 7

Primary treatment of ocular surface squamous neoplasia. (a) Nodular lesion with abundant keratin at the limbus. (b) Immediate postoperative appearance following complete excision with margin clearance, double freeze cryotherapy and ocular surface reconstruction with amniotic membrane transplantation with tissue glue

Figures 8

(a) Conjunctival nevus with intralesional cysts and feeder vessels. (b) Microphotograph of a subepithelial nevus showing clumps of melanocytes with no cellular atypia (OM ×40)

Figure 9

Ocular melanocytosis showing episcleral pigmentation

Figure 10

Primary acquired melanosis (PAM). (a) Diffuse flat pigmentation of the bulbar conjunctiva in an elderly male. (b) Microphotograph of PAM with cellular atypia (OM ×10)

Figure 11

Conjunctival melanoma. (a) Elevated, nodular, pigmented mass at the inferior limbus with extension into the peripheral cornea. Note the presence of feeder vessels and intrinsic vessels. (b) Microphotograph of conjunctival melanoma showing variably pigmented melanocytes with mitotic activity (OM ×40)

Figure 12

Vascular lesions of the conjunctiva. (a) Reddish pedunculated mass seen in the bulbar conjunctiva, at the site of prior surgical resection of pterygium. (b) Diffuse eyelid hemangioma with a conjunctival component. (c) Diffuse ill-defined bluish lesion seen in the inferior fornix suggestive of the conjunctival varix. (d) Diffuse reddish lesion with multiple dilated cystic spaces is seen in the inferomedial fornix. There are blood filled cysts noticed

Figure 13

Conjuctival lymphoma. (a) Superior bulbar conjunctiva shows typical salmon pink mass with cork-screw vessels. (b) Microphotograph of conjunctival lymphoma (OM ×40). Note the monomorphic appearance of cells

Figure 14

Conjunctival extension of orbital rhabdomyosarcoma

Figure 15

Counjunctival choristoma. (a) Preauricular tags in a patient with limbal dermoid suggestive of Goldenhar syndrome. (b) Limbal dermoid with hair follicle on the surface. (c) Dermolipoma manifesting as a yellow-white smooth lesion in the lateral fornix with a co-existing limbal dermoid. (d) Microphotograph of dermolipoma (OM ×10) showing conjunctival epithelium lining its surface and sub-epithelial tissue with collagenous connective tissue and adipose elements

Figure 16

Caruncular tumors. (a) Pigmented caruncular nevus. (b) Squamous cell carcinoma arising from the caruncle