Conjunctival Squamous Cell Carcinoma with Intraorbital and Intraocular Invasion

A 64-year-old male with a history of T2DM and HTN was referred for 2 weeks of severe pain and redness in the right eye. Two months earlier, he had undergone reported pterygium removal surgery in another country. At presentation, vision in the right eye was hand motion and the intraocular pressure was elevated at 33mmHg. Slitlamp biomicroscopy showed temporal corneoscleral thinning with visible bare sclera, enlarged scleral vessels, irregular/elevated conjunctiva, and diffuse corneal haze. The patient was diagnosed with presumed infectious sclerokeratitis after pterygium removal. Corneal and scleral cultures were obtained, and the patient was started on topical fortified antibiotics and oral moxifloxacin. However, the patient did not improve, and he was taken to the OR for scleral exploration with intra-stromal antibiotics, tissue biopsy, and cryotherapy. Tissue biopsy was positive for well-differentiated squamous cell carcinoma. MRI of the brain, orbits, and neck revealed enhancing mass in the superolateral aspect of the right orbit with involvement of superior muscle complex, lateral rectus muscle, and lacrimal gland. There was no CNS mass, neck mass, or cervical lymphadenopathy. Because of the extensive intraorbital involvement at the time of the diagnosis, orbital exenteration was performed. 

Presentation Date: 03/05/2020

Issue Date: 08/01/2020