Ocular Surface Squamous Neoplasia

A patient presented to BPEI for a cornea evaluation with blurred vision, foreign body sensation and redness for 1 year duration. The exam was notable for visual acuity of 20/150 in the right eye. Intraocular pressure was 8 in the right eye, Slit lamp exam was most notable for conjunctival injection, gelatinous pinguecula located at 4 to 5 clock hours, and significant generalized PEE. Past relevant medical history, significant sun exposure, suspicious skin lesion on hand, family h/o cancer in both parents. This clinical picture could simulate multiple ocular surface diagnosis including dry eye disease, HSV, medicamentosa, or even allergic conjunctivitis. The patient was treated outside our facility with topical steroids, but had multiple recurrences so he came for a second opinion to BPEI. An anterior segment OCT had classic findings of OSSN. Diagnosis was confirmed by pathology via conjunctival biopsy and corneal scraping. Patient underwent 6 cycles (1 week on, 3 weeks off) of 5 fluorouracil. Patient’s symptoms resolved, vision improved to 20/25, anterior segment OCT was used to follow treatment response. Currently, the patient is being followed with anterior segment OCT to look for recurrence.

Presentation Date: 05/26/2022

Issue Date: 06/17/2022