Friday, January 1, 2016

Doctor, can you remove these lumpy things from my eye?

This young man presented with these lumpy lesions of his right eye for the past 3 months. He has had similar condition 6 months earlier and consulted a different eye doctor. The lesions were excised at that time without further treatment and they returned with a vengeance. 

Conjunctival papillomas affecting the upper and lower tarsal conjunctiva.

Examination revealed multiple pendunculated lesions arising from the upper and lower tarsal conjunctiva and the patient had problem shutting the eye properly. The lesions are typical of conjunctival papillomas. These lesions are benign and are associated with huma papillomavirus (HPV) infection. Although they can be excised easily, recurrence is common unless adjunctive therapy was performed. 

In this patient, the lesions were excised followed by application of 0.01% of mitomycin to the bases for one minute. So far, the patient showed no recurrence at follow-ups. 

The upper eyelid was everted with Desmarres retractor to fully 
expose the affected tarsal conjunctiva.

The lesions were excised using a blade and the bases scrapped clean.

Cotton bud dipped in 0.01% mitomycin was applied to the bases 
for one minute.

At follow-up, there was no recurrence.

At follow-up, the tarsal conjunctiva appeared free of papilloma.

Conjunctival papilloma: features and outcomes based on age at initial examination. Kaliki S, Arepalli S, Shields CL, Klein K, Sun H, Hysenj E, Lally SE, Shields JA. JAMA Ophthalmol. 2013 May;131(5):585-93.

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