EW CORNEA
118
October 2015
by Lauren Lipuma EyeWorld Staff Writer
is typically a hyperreflective, unin-
volved area surrounding the dark
lesion."
How to recognize
and treat 3 types of
malignant lesions
I
n the clinic, patients can pres-
ent with a variety of conjunc-
tival lesions. It can be difficult
to differentiate between the
types of lesions, but according
to Zaina Al-Mohtaseb, MD, assis-
tant professor and assistant resi-
dency program director, Cullen Eye
Institute, Baylor College of Medi-
cine, Houston, there are 3 types of
malignant lesions a clinician should
never miss: conjunctival lymphoma,
conjunctival melanoma, and ocular
surface squamous neoplasia (OSSN).
Speaking at the 2015 Combined
Ophthalmic Symposium in Austin,
Texas, Dr. Al-Mohtaseb described the
clinical features of these 3 lesions,
how to differentiate between them,
and pearls for diagnosis and treat-
ment.
Conjunctival lymphoma
Conjunctival lymphoma usually
occurs in older patients (50 years or
older) or patients who are immuno-
compromised. Most (98%) are B-cell
non-Hodgkin lymphomas, and a
small percentage are T-cell lympho-
mas. Most lymphomas are found in
the fornix or the bulbar conjunctiva,
and 20% have an underlying extra-
ocular lymphoma.
During the exam, look for a
mobile, salmon pink, or multinodu-
lar mass and make sure to evert the
eyelids. Twenty percent of conjunc-
tival lymphomas have bilateral in-
volvement, so make sure to examine
both eyes. Do a dilated fundus exam
to check for intraocular spread and
do a biopsy.
"During my training with Carol
Karp, MD, Miami, I found that
high-resolution anterior segment
OCT is very helpful in diagnosing
these lesions and in differentiating
them from others," Dr. Al-Mohtaseb
said. "They show up on OCT as
large, dark, hyporeflective areas
beneath a thin epithelial layer. There
Conjunctival lesions demystified
With lymphoma, the epithelium is thin and dark, with a hyporeflective (dark) subepithelial
lesion; there is often a hyperreflective, uninvolved area seen around the lesion.
