2-23 - Conj.Tumours+Degen

Question 1

Pinguecula

Answer 1

• Degen of elastic tissue + collagen at conjunctival stroma
• Common + innocuous (only irritate if large or inflammed)
• Due to chronic UV + surface dryness
• Yellow-white elevated lesiojn on bulbar conjunctiva, near limbus, due to subepithelial prolif of fibrovascular tissue.
• Can have calcification
• Usually bilateral

Question 2

Pterygium

Answer 2

• Fibrovascular subepithelial ingrowth of degenerative conjunctival stroma
• Similar pathophysiology + history to pinguecula, sometimes even arising from it
• Reaches over limbus, onto cornea, invades bowman’s layer
• Triangular (cap, head, body), very vascularised, conjunctival overgrowth on cornea
• Iron deposit possible at apex (stocker’s line)
• Chronic irritation, vision impairment, can affect corneal curvature for astig
• Tend to be nasal

Question 3

Conjunctivochalasis

Answer 3

• Excess conjunctival tissue sitting between eye and lower lid
• Benign, age-related, worse w/ inflammation or mech stress
• Bilateral, loose/slack, redundant bulbar conjunctiva. Very movable
• If symptomatic, has dry eye + epiphoria (excess tearing as it occludes puncta)

Question 4

Conjunctival naevus

Answer 4

• Melanocyte prolif at area between conj epithelium and subepithelial CT
• Uncommon, benign
• Unilateral, solitary, flat/slightly elevated, well circumscribed, very visible
• Variable size, pigment, often near limbus, mobile over sclera
• Often has small cysts inside
• <1% malignancy

Question 5

Ethnic melanosis

Answer 5

• More melanin at conjunctiva as oppose to more melanocytes
• Darker skin ppl more likely
• Bilateral, stable in adulthood, no need to worry.

Question 6

Conjunctival melanoma

Answer 6

• Unregulated atypical melanocyte proliferation w/ stromal invasion
• Uncommon, serious (recurrence + metastasis high)

A = Asymmetry

B = Border poorly defined

C = Colour really deep

D = Diameter large

E = Evolving (changes over time)

• Due to Primary Aquired Melanosis (PAM)
• Black/grey solitary nodule w/ associated vascularity
• Commonly at limbus

Question 7

Primary Acquired Melanosis
- General information
- Management

Answer 7

• Irregular, uni- or multifocal, flat, patchy areas of pigment
• PAM w/o atypia = benign prolif of normal melanocytes at basal conj. epithelium
• PAM w/ atypia = pre-malignant prolif of atypical melanocytes in all conj. epithelial layers (high malignant chance)
• Uncommon, unilateral
• In middle-aged white ppl
  Management:
• Denote severity using clock hours
• Small lesions (1-2hrs) w/o nodules, thickening, or vascularisation is monitored yearly
• Larger lesions w/ suspesious activity needs excision
• Get all melanotic lesions checked by ophthalmologist.

Question 8

Conjunctival papilloma?

Answer 8

• Prolif of squamous conj. epithelial cells (surround fibrovascular core)
• Acquired benign tumour
• associated w/ HPV types 6 + 11
• Sessile = broad flat, large wide base, gelatinous
• Pedunculated = rough, convoluted, cerebrofoam surface appearance
• Hairpin appearance of underlying BVs
• Symptoms depend on location and size e.g. FB sensation, dryness due to tear film instability near papilloma, haemorrhage possible…
• Rare malignancy potential

Question 9

Conjunctival Intraepithelial Neoplasia

Answer 9

• Unregulated prolif of atypical squamous conj. Epithelium
• pre-cancerous (can lead to squamous cell carcinoma)
• Rare, unilateral, slightly elevated, fleshy gelatinous mass (either leukoplakic = whitening or papillomatous)
• Mostly at limbus due to active mitotic cells
• Slow growing
• Superficial or feeder BVs possible
  Symptoms:
• Redness
• FB sensation
• Mild irritation

Question 10

Subcojunctival haemorrhage

Answer 10

Rupture of conj. BVs
- Blood accumulates between conj. and episclera
- Very common, mostly idiopathic, more likely w/ age, can be from trauma/surgery
- Variable appearance (dot-blot or extensive)
- Acute, asymptomatic (no pain, discharge, inflammation) w/ spontaneous resolution