Abstract

DO.24.03

Bilateral ocular surface squamous neoplasia and neurodermatitis: Two cases with different courses

Gericke A.¹, Pitz S.¹, Strempel I.², Sekundo W.^1
1Department of Ophthalmology, University of Mainz, Mainz; ²Department of Ophthalmology, University of Marburg

Objective: Ocular surface squamous neoplasia (OSSN) is a rare disease with an incidence of 0.02-3.5 per 100 000 population. Known risk factors are extensive solar exposure, smoking, human papilloma virus infection, and HIV. In addition, recent data suggest that neurodermatitis is a risk factor for OSSN. In the present report we describe two cases of bilateral OSSN associated with neurodermatitis.
Results: Both patients had a history of neurodermatitis diagnosed in their childhood. Patient 1 (41, male) presented with conjunctival neoplasia of the left lower fornix. Following excision, intraepithelial squamous neoplasia was histologically diagnosed. After 3 years, biopsy of a recurrency revealed a highly differentiated conjunctival carcinoma, which was excised in toto. 2 years later, the patient presented with a conjunctival neoplasia located on the lower lid margin of the fellow eye, which was successfully treated by topical application of mitomycin C.
Patient 2 (60, male) presented with extensive bilateral conjunctival neoplasia that developed within 3 months following conjunctivitis. Due to extensive corneal invasion visual acuity was reduced to counting fingers and light perception in the left and the right eye. Following conjunctival biopsy, intraepithelial squamous cell dysplasia was diagnosed. Tests for human papilloma virus and HIV were negative. Topical application of mitomycin C inhibited neoplasm expansion. However, the patient developed a descemetocele of the left cornea. Thus, an excision of the neoplasia was combined with corneal abrasion, and the defect covered with a free oral mucosal graft. 5 months later, no progression was observed in the operated eye. However, on the nasal limbus of the fellow eye an increase of the neoplasia was seen.
Conclusions: The cases support the hypothesis that neurodermatitis is a risk factor for OSSN. Early surgical removal of lesions supplemented by topical mitomycin C application is an effective method of treatment. In order to detect new lesions at an early stage, regular ophthalmologic examinations should be performed.

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