Good Hope, Heartlands, and Solihull Eye Clinics

conjunctival lesions

David Kinshuck

 

None-pigmented

  • Papilloma
  • ocular neoplasia
  • sebaceous cc

Pigmented

  • Naevus
  • primary acquired melanosis
  • melanoma

Naevus

  • Naevus appears within 2 decades of life
  • interpalpebral  usually 
  • Naevus have cystic change
  • No growth after adolescence 
  • Compound naevi in stroma and superficial 
  • Naevi don't recur
  • naevi can be blue, brown, black,
  • are benign 

Inflamed juvenile conjunctival naevi

  • feeder Vessels
  • Benign limbal child adolescence, do grow in puberty, juicy and fleshy, little cysts, half amelanotic, atopic,

Pam: primary acquired melanosis

  • White patients, usually unilateral, middle y,elderly  ,
  • if moves, conjunctiva..uses cotton bud
  • Multifocal, limbal, interpalpebral
  • Sunlight exposure, cigarette, hypertension, 
  • Histopathology 
    With atypia, mitomycin, or cryo, steroids,
    Observe if no atypia 
    Need specialist care..cause 75% melanomas...comes from atypia 

Naevus of Ota

  • Periocular pigmentation also
  • Can be covered with make up
    Half present at brith
  • other half age 20, oriental
  • 30x risk of uveal melanoma
  • Watch patients annually

Melanoma

  • follow Pam: primary acquired melanosis, 1/5 from naevi, some from naevus of Ota
  • Onset as adult
  • Change in colour
  • Recent growth 
  • Palpebral or fornix..melanoma
  • If recurred not naevus
  • Multifocal 

Management of conjunctival lesions

Do you know what lesion is
Yes...if benign, observe
Malignant..refer

No
Don't biopsy, refer
60% recur
Excise cryo, amg, post op ruth plaque

Worse 
None bulbar
None limbal 
Multifocal 

 


Ocular surface squamous neoplasia

  • Sunlight
  • Papilloma virus
  • Hiv
  • Types..2
  • Papilliform and leukoplakia
  • Histopathology diagnosis
  • Surgery and amg mito interferon