Pterygium Surgery: Trap to Avoid
DOI:
https://doi.org/10.55677/IJCSMR/V2I7-04/2022Keywords:
ocular-surface squamous neoplasia, pterygiumAbstract
We report the case of an 86-year-old man, operated for pterygium twice in 2015 and 2017, as far as the history of the disease is concerned, it dates back four years to the appearance of a conjunctivo-limbic swelling of the left eye operated twice as a pterygium.
The evolution was marked by a rapid recurrence with appearance of cauliflower swelling.
At the slit lamp we found at the level of the left eye a swelling in bouquet or in conjunctival cauliflower invading the limbus and cornea in temporal and superior with superficial punctate keratitis.
The patient was admitted to a specialized center for chemotherapy.
Pterygium is a known benign condition whose radical treatment is surgical. But it should not be underestimated because it may be a differential diagnosis.
In particular conjunctival intraepithelial neoplasia (formerly Bowen's disease), hence the interest of biopsy with histopathological examination, whenever the pterygium seems atypical.
The interest of our case is to show that it should always be kept in mind that in some cases, the diagnosis of a pterygium may in fact turn out to be an ocular-surface squamous neoplasia.
References
- Chaidaroon W, Dejkriengkraikul C, Isipradit S, Lertprasertsuke N: Conjunctival Intraepithelial Neoplasia in a Patient Presenting with Pigmented Conjunctival Lesion. Case Rep Ophthalmol 2021;12:77-82.
- Lee GA, Williams G, Hirst LW, Green AC. Risk factors in the development of ocular surface epithelial dysplasia. Ophthalmology. 1994 Feb;101(2):360–4.
- Lee GA, Hirst LW. Ocular surface squamous neoplasia. Surv Ophthalmol. 1995 May-Jun;39(6):429–50.
- Napora C, Cohen EJ, Genvert GI, Presson AC, Arentsen JJ, Eagle RC, et al. Factors associated with conjunctival intraepithelial neoplasia: a case control study. Ophthalmic Surg. 1990 Jan;21(1):27–30.
- Shields CL, Manchandia A, Subbiah R, Eagle RC Jr, Shields JA. Pigmented squamous cell carcinoma in situ of the conjunctiva in 5 cases. Ophthalmology. 2008 Oct;115(10):1673–8.
- Mauriello JA Jr, Napolitano J, McLean I. Actinic keratosis and dysplasia of the conjunctiva: a clinicopathological study of 45 cases. Can J Ophthalmol. 1995 Oct;30(6):312–6
- Sarda V., Gheck L. Chaine G. Ptérygions. EMC (Elsevier Masson SAS, Paris), Ophtalmologie, 21-135-A-10, 2010.
- Nampei K, Oie Y, Kiritoshi S, et al. Comparison of ocular surface squamous neoplasia and pterygium using anterior segment optical coherence tomography angiography. Am J Ophthalmol Case Rep. 2020;20:100902. Published 2020 Aug 27.
