A retrospective study of conjunctival lesions in the Paediatric Eye Clinic over 12 years

Abstract

Background: Paediatric conjunctival lesions are rare and diverse. Though often indolent and asymptomatic, they can in some cases be sight or life-threatening. Awareness of concerning features of conjunctival lesions is key to optimal management. We aim to provide insight into management of paediatric conjunctival lesions though a review of cases in our service in last 12 years.

Methods: We present a retrospective analysis of our population-based cohort of children with conjunctival lesions presenting to our regional service in Belfast between 2011 and 2022 inclusive. We detail three rare cases of paediatric conjunctival lesions; a congenital intrascleral cyst leading to astigmatic amblyopia, a rapidly changing salmon-pink lesion confirmed as an embryonal rhabdomyosarcoma and an unusual presentation of a chronic granuloma arising from the caruncle.

Results: 85 conjunctival lesions were identified in <16 year olds giving a cumulative incidence of 27 cases per 100,000 population over 12 years. Mean age at presentation was 7 years old. Most common lesions were naevi (40%), limbal dermoids (21%), conjunctival melanosis (14%), conjunctival cysts (7%) and phlycten (6%). When seen at presentation 8% of cases were immediately listed for surgery, 28% were discharged and 64% entered a phase of observation.

Conclusion: Paediatric conjunctival lesions have potential to cause visual manifestations, whilst some may undergo malignant transformation. Anterior segment photography is crucial in monitoring change and facilitating early discharge in the absence of sinister features. Malignant transformation must be considered in changing lesions which ought to have histological diagnosis obtained to prevent potentially sight and life-threatening conditions.

Fig. 1. A congenital intrascleral cyst in the left eye.

a Lesion at presentation. b Lesion 3 months later.

Fig. 2. Conjunctival lesion caused by embryonal rhabdomyosarcoma in the lateral bulbar conjunctiva of the left eye.

a Lesion at presentation. b Lesion three weeks post presentation; rapid transformation into a rubbery polypoid lesion. c Extension of the lesion under the upper and lower lids demonstrated by gentle traction of the lids.

Fig. 3. Left eye caruncular granuloma.

a The granuloma as seen with the left eye in primary position. b In abduction and elevation, the lesion can be seen to arise from the caruncle.