Conjunctival lesion Image: Associate Professor Mark Roth
Associate Professor Mark Roth
BSc(Pharmacology) BAppSc(Optom) PGCertOcTher NEWENCO FAAO OAM
A 48-year-old, Caucasian woman presents with a long-standing, large, right inferiotemporal, oval, conjunctival lesion. The lesion is 6 mm in diameter and 3 mm thick, with associated dilated blood vessels. There is a yellow-white corneal line adjacent to lesion and one prominent follicle and hair in the centre of the mass. The patient is asymptomatic.
What is your diagnosis?
DIAGNOSIS: Large conjunctival dermoid
Conjunctival dermoid can occur as an isolated lesion, as in this case, or it can be a component of Goldenhar syndrome.
Dermoids can appear in various sizes as a yellow-white limbal mass, usually inferotemporally but can appear in other meridians. The size can range from 2 mm to 15 mm in diameter, and 0 to 10 mm in thickness. Fine white hairs often protrude from the lesion as well as a yellow-white lipid line in the adjacent corneal stroma.
Larger dermoids can cause ocular surface irritation and astigmatism. Histopathologically, dermoid is lined by stratified squamous epithelium and deep to the epithelium is dense collagenous tissue.
Smaller, asymptomatic lesions can be observed and monitored. Alternatively, surgical removal can be considered. Reasons for surgical removal include: secondary astigmatism, encroachment on visual axis, ocular surface irritation, dellen formation and cosmetic reasons.
For excision a combination of lamellar keratoplasty, amniotic membrane and stem cell replacement can be employed.
Jerry A Shields and Carol L Shields. Eyelid, Conjunctival and Orbital Tumors: An Atlas and Textbook, 3rd edition. Wolters Kluwer 2016.