Cornea Cases

Title:

Clinical Features and Management of Recurrent Ocular Surface Squamous Neoplasia

Case Report Details

First Author: G.Brown UK

Co Author(s):    S. Srinivasan                    

Abstract Details

Purpose:

To report the clinical presentation and management of a case of recurrent ocular surface squamous neoplasia

Setting:

Department of Ophthalmology, University Hospital Ayr, Ayr, Scotland.

Report of case or case series:

In August 2014, a 73 year-old Caucasian male was referred to eye casualty with a 1-month history of worsening foreign body sensation in the left eye. He had no prior ocular history and systemic medical history included atrial fibrillation and type 2 diabetes. Slit lamp biomicroscopy revealed a 7mm x 5mm raised lesion with papillary elevation and telangiectatic vessels invading the peripheral corneal between 3 and 5 o’clock in left eye. The clinical features were highly suggestive of ocular surface squamous neoplasia. Examination of the right eye was normal and visual acuity was 6/9 bilaterally. In September 2014, he underwent excision of the left eye tumour with concomitant cryotherapy and ocular surface reconstruction with amniotic membrane. Chloramphenicol eye drops were prescribed for the immediate post-operative period, alongside a tapering schedule of Pred-Forte eye drops. Histology results confirmed a diagnosis of ocular surface squamous neoplasia. At the 4-month post-operative visit, the graft had healed well and steroid drops were stopped. He remained in remission for several years and was followed-up regularly throughout, with his visit in January 2020 confirming no recurrence at that time. In November 2020 he returned to clinic reporting a 1-month history of conjunctival redness. Examination revealed conjunctival inflammation in the area of prior ocular surface squamous neoplasia, highly suspicious of a recurrence. He was subsequently treated with topical interferon alpha-2b eye drops.

Conclusions/Take Home Message:

Ocular surface squamous neoplasia has a high risk of recurrence. Recurrent cases need to be managed aggressively with an appropriate treatment strategy based on clinical presentation and histology.