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Cornea Sep 2022The purpose of this study was to report a unique case of ocular surface squamous neoplasia that masqueraded as a nonresolving toxic epithelial keratitis. (Review)
Review
PURPOSE
The purpose of this study was to report a unique case of ocular surface squamous neoplasia that masqueraded as a nonresolving toxic epithelial keratitis.
METHODS
This was a case report and review of the literature.
RESULTS
A 79-year-old man presented with decreased vision, redness, and a foreign body sensation in his right eye that was refractory to treatment with lubrication and topical nonsteroidal antiinflammatory drops. Before presentation, the referring provider believed that he had medicamentosa-related keratitis and placed him on oral methazolamide. Slitlamp biomicroscopy of the right eye revealed diffuse epitheliopathy with punctate fluorescein staining and subtle underlying corneal epithelial opalescence. A mildly thickened and inflamed pinguecula was noted from 2 to 5 o'clock at the limbus of the right eye. An anterior segment high-resolution optical coherence tomography revealed thickened, hyperreflective epithelium with an abrupt transition. An incisional biopsy confirmed conjunctival and corneal intraepithelial neoplasia. The patient improved after 4 cycles of topical chemotherapy with 1% 5-fluorouracil eye drops with complete resolution of the corneal and conjunctival pathology.
CONCLUSIONS
Ocular surface squamous neoplasia can rarely masquerade as a recalcitrant medicamentosa and epithelial keratitis. In subtle cases or in cases with combined ocular surface morbidities, anterior segment high-resolution optical coherence tomography can be helpful to diagnose and direct therapy.
Topics: Aged; Carcinoma, Squamous Cell; Conjunctival Neoplasms; Corneal Diseases; Eye Neoplasms; Humans; Keratitis; Male; Tomography, Optical Coherence
PubMed: 34907943
DOI: 10.1097/ICO.0000000000002946 -
Scientific Reports Dec 2021Recently, it has been recommended that population-based studies report not only frequencies of vision impairment and blindness but also any ocular abnormalities that...
Recently, it has been recommended that population-based studies report not only frequencies of vision impairment and blindness but also any ocular abnormalities that might lead an individual to seek for eyecare services. The current study aimed to determine prevalence of ocular findings regardless of visual acuity (VA) status in older adults from the Brazilian Amazon Region. Disturbances were grouped into: Eyelids; Anterior Segment; Posterior Segment; Increased intraocular pressure; and Overall Globe. The presence of an ocular finding was considered positive when any abnormality was noted, regardless of VA. Refractive errors were not considered. A total 2384 eligible persons were enumerated and 2041 (85.6%) examined. The prevalence of ocular disturbances in either eye was 87.0% and was associated with male gender, older age, lower education, and rural residence. Overall, main findings were pterygium, cataract, and pinguecula, occurring in 58.8%, 45.4% and 17.4%, respectively. Among individuals with 20/20 VA in both eyes, the most frequent findings were pterygium, pinguecula, and glaucoma cupping, occurring in 47.4%, 31.2% and 6.5%, respectively. The high prevalence of ocular findings observed in this population reinforces that different conditions might not immediately decrease VA but can indicate risk and/or discomfort symptoms and should be considered when planning public health ophthalmic services.
Topics: Age Factors; Aged; Aged, 80 and over; Brazil; Eye Diseases; Female; Geriatric Assessment; Humans; Male; Middle Aged; Population Surveillance; Prevalence; Risk Factors; Visual Acuity
PubMed: 34887482
DOI: 10.1038/s41598-021-03172-4 -
International Journal of Molecular... Nov 2021Solar damage due to ultraviolet radiation (UVR) is implicated in the development of two proliferative lesions of the ocular surface: pterygium and pinguecula. Pterygium...
Solar damage due to ultraviolet radiation (UVR) is implicated in the development of two proliferative lesions of the ocular surface: pterygium and pinguecula. Pterygium and pinguecula specimens were collected, along with adjacent healthy conjunctiva specimens. RNA was extracted and sequenced. Pairwise comparisons were made of differentially expressed genes (DEGs). Computational methods were used for analysis. Transcripts from 18,630 genes were identified. Comparison of two subgroups of pterygium specimens uncovered evidence of genomic instability associated with inflammation and the immune response; these changes were also observed in pinguecula, but to a lesser extent. Among the top DEGs were four genes encoding tumor suppressors that were downregulated in pterygium: , , and ; and were also downregulated in pinguecula. Ingenuity Pathway Analysis overwhelmingly linked DEGs to cancer for both lesions; however, both lesions are clearly still benign, as evidenced by the expression of other genes indicating their well-differentiated and non-invasive character. Pathways for epithelial cell proliferation were identified that distinguish the two lesions, as well as genes encoding specific pathway components. Upregulated DEGs common to both lesions, including and , provide a further insight into pathophysiology. Our findings suggest that pterygium and pinguecula, while benign lesions, are both on the pathological pathway towards neoplastic transformation.
Topics: Biomarkers; Case-Control Studies; Genomic Instability; Humans; Inflammation; Pinguecula; Pterygium; RNA-Seq; Transcriptome; Ultraviolet Rays
PubMed: 34769520
DOI: 10.3390/ijms222112090 -
Der Ophthalmologe : Zeitschrift Der... Nov 2021
Topics: Conjunctiva; Humans; Pinguecula; Pterygium
PubMed: 34542694
DOI: 10.1007/s00347-021-01500-7 -
Der Ophthalmologe : Zeitschrift Der... Nov 2021
Topics: Conjunctiva; Conjunctival Diseases; Humans; Pinguecula; Pterygium
PubMed: 34542693
DOI: 10.1007/s00347-021-01502-5 -
Clinical Ophthalmology (Auckland, N.Z.) 2021Everybody is exposed to ultraviolet radiation and the natural source of ultraviolet radiation is sunlight. The objective of this study was to determine the prevalence of...
BACKGROUND
Everybody is exposed to ultraviolet radiation and the natural source of ultraviolet radiation is sunlight. The objective of this study was to determine the prevalence of solar keratopathy, pterygium and cataract and further to evaluate other factors that cause blindness to the inhabitants of the Northern Red Sea Zone islands of Eritrea.
METHODS
It was a community-based cross-sectional study of all people aged 40 years and above, with a census sampling method. Study participants were screened for presence of solar keratopathy and other ocular diseases, and data were collected by a checklist from March 20 to April 20, 2021. Data were entered on an Excel sheet and transported to SPSS version 21. Results were presented with frequencies and percentages and chi-squared bivariable analysis was carried. -value less than 0.05 was considered significant.
RESULTS
The prevalence of solar keratopathy and cataract was 19.6% and 15.8%, respectively. Pterygium (40%) and pinguecula (32.1%) were also commonly found in the community. Participants aged 70 years and above (<0.001), fishermen (<0.001), housewife (<0.001) and females (<0.001) had a higher rate of blindness. The prevalence of solar keratopathy was higher with increased age and work experience (<0.001). Fishermen and housewives had higher rates of solar keratopathy (44.6%) and cataract (30.2%), respectively, (<0.001). Respondents aged 40 to 49 years had the highest prevalence of pterygium (44.1%) and pinguecula (39.1%) (<0.001).
CONCLUSION
The prevalence of solar keratopathy, cataract, pterygium and pinguecula was high in the community. Fishermen with increased work experience were having the highest prevalence of blindness and solar keratopathy. Age, occupation, work experience, sex, vision problems and history of eye operations had showed significant association with visual acuity, solar keratopathy, cataract, pterygium, and pinguecula. Community awareness about the preventive aspects of these diseases is highly recommended.
PubMed: 34285465
DOI: 10.2147/OPTH.S321413 -
Therapeutic Advances in Ophthalmology 2021This study aimed to determine the relationship between clinical symptoms and findings of patients diagnosed with conjunctivochalasis in our clinic and the risk factors...
OBJECTIVE
This study aimed to determine the relationship between clinical symptoms and findings of patients diagnosed with conjunctivochalasis in our clinic and the risk factors reported in the literature, to determine new possible etiological factors, and to compare routine tear assessment methods with novel strip meniscometry in these patients.
MATERIALS AND METHODS
The study included patients who presented to our clinic between March 2019 and June 2019 and were diagnosed with conjunctivochalasis. The Ocular Surface Disease Index was used to assess ocular surface symptoms. Anterior segment examination included tear break-up time, corneal staining, localization of conjunctivochalasis, and the presence of pinguecula or pterygium. For each patient, tears were measured using both Schirmer and strip meniscometry. Patients with conjunctivochalasis were evaluated as lid-parallel conjunctival folds grade 1, 2, or 3.
RESULTS
There was a total of 57 participants, including 31 women (54.4%) and 26 men (45.6%). Lid-parallel conjunctival folds grade was found to be statistically significantly associated with dust exposure ( = 0.034). Multiple regression analysis revealed that dust exposure was an independent predictor of being diagnosed with lid-parallel conjunctival folds grade 2 lid-parallel conjunctival folds grade 1 (odds ratio = 3.515, = 0.029). Moreover, Schirmer's test and strip meniscometry results were positively correlated in patients with conjunctivochalasis ( = 0.302 and = 0.022).
CONCLUSION
We conclude that external factors are prominent in patients with conjunctivochalasis, especially dust exposure. In addition, strip meniscometry may be preferred as a more practical and noninvasive alternative to investigate dry eye symptoms in patients with conjunctivochalasis.
PubMed: 34263137
DOI: 10.1177/25158414211027757 -
BMJ Case Reports May 2021Diagnosis of rare disorders requires heightened clinical acumen. When such disorders present with atypical or novel features, it adds to the diagnostic challenge. A...
Diagnosis of rare disorders requires heightened clinical acumen. When such disorders present with atypical or novel features, it adds to the diagnostic challenge. A 9-month-old female infant who had received a diagnosis of neonatal hepatitis due to cytomegalovirus infection at 2 months of age presented to our institute with developmental delay, fever, vomiting, feeding difficulty, breathlessness and features of elevated intracranial pressure due to hydrocephalus. Key examination findings with cholestatic jaundice as an early manifestation led to suspicion of type 4 Farber disease. Observation of hydrocephalus, hypertension, bilateral pinguecula and Erlenmeyer flask deformity of the femur were unusual findings for Farber disease. The child had few features (pinguecula, Erlenmeyer flask deformity and hydrocephalus) overlapping with Gaucher disease. Alternatively, prosaposin deficiency (Farber disease type 7) was another differential diagnosis. Diagnosis of Farber disease was confirmed by detection of foamy macrophages on skin biopsy and two homozygous missense variants in gene.
Topics: Child; Farber Lipogranulomatosis; Female; Femur; Gaucher Disease; Humans; Infant; Infant, Newborn; Mutation, Missense; Skin
PubMed: 34045195
DOI: 10.1136/bcr-2020-240742 -
American Journal of Ophthalmology Sep 2021To characterize the clinical and histopathologic features of actinic granuloma of the conjunctiva. (Review)
Review
PURPOSE
To characterize the clinical and histopathologic features of actinic granuloma of the conjunctiva.
DESIGN
Retrospective observational case series METHODS: Institutional pathology records between 2014 and 2020 were searched for all cases of conjunctival actinic granuloma. Information collected included age, sex, ocular and medical history, clinical findings, laboratory workup, treatment, follow-up, pathologic diagnosis, and histopathologic inflammation pattern.
RESULTS
Eight eyes of 8 patients, 5 men and 3 women, with a median age of 43 years (mean 49, range 24-83) were identified. Clinical diagnosis was pterygium (n = 4, 50%), inflamed pterygium (n = 1, 13%), pterygium vs conjunctival squamous cell carcinoma (n = 1, 13%), episcleritis vs inflamed pinguecula (n = 1, 13%), and scleritis vs keratoacanthoma (n = 1, 13%). Of 5 lesions with follow-up information, none recurred following excision with a median follow-up of 9 weeks (mean 19 weeks, range 1-61 weeks). Allergy/atopy was documented in 4 of 7 (57%) patients with available medical information. There were no other systemic associations. Histopathologically, actinic granuloma was associated with pterygium (n = 6, 75%) and pinguecula (n = 2, 25%). All lesions were composed predominantly of histiocytes and a variable number of foreign body-type giant cells associated with a focus of severe actinic elastosis. The inflammatory pattern was giant cell (n = 4, 50%), sarcoidal (n = 2, 25%), histiocytic (n = 1, 13%), and combined histiocytic and sarcoidal (n = 1, 13%).
CONCLUSION
Conjunctival actinic granuloma has diverse clinical and histopathologic manifestations, which need to be distinguished from other autoimmune, neoplastic, and infectious etiologies. This lesion frequently occurs in pre-existing pterygium and pinguecula and may be associated with allergy and atopy.
Topics: Adult; Conjunctiva; Female; Granuloma; Humans; Male; Neoplasm Recurrence, Local; Pterygium; Retrospective Studies
PubMed: 33895150
DOI: 10.1016/j.ajo.2021.04.006 -
Ophthalmic Plastic and Reconstructive...To document a case of actinic granuloma (AG) of the conjunctiva, provide an extensive histopathologic and immunohistochemical description, review previously reported... (Review)
Review
PURPOSE
To document a case of actinic granuloma (AG) of the conjunctiva, provide an extensive histopathologic and immunohistochemical description, review previously reported cases, and supply a differential diagnosis.
METHODS
Both a retrospective chart review and comprehensive literature review were performed. The distinctive histopathologic pattern of the current case was defined with histochemical and immunohistochemical stains (CD163, p63, and a Verhoeff-Van Gieson elastic stain). Clinical follow up was obtained.
RESULTS
A granulomatous process composed of CD163-positive mononuclear epithelioid cells and multinucleated giant cells was characterized by displaced extracellular actinic-related elastic fibers to the base of the lesion. Small elastic fibers were phagocytosed in epithelioid cells. Pseudoepitheliomatous hyperplasia of the overlying squamous epithelium was present; p63 assisted in defining the squamous proliferation and highlighted its noninvasive nature. Conjunctival AGs, according to the literature review, occur almost exclusively in young females, clinically manifest as nodular foci with painless injection over the course of weeks, and histologically featured granulomatous inflammation and elastophagocytosis. The etiology of this entity is likely multifactorial, but its genesis revolves around actinic injury.
CONCLUSION
AGs of the conjunctiva have likely been an underreported entity in the past. The authors' review underscores the importance of including conjunctival AGs in the differential diagnosis of painless, subacute injected masses of the perilimbal conjunctiva. While it is benign, histopathologically separating AGs from neoplasia and other mimickers such pinguecula, foreign body granulomas, allergic, or rheumatoid nodules is essential for optimal management.
Topics: Conjunctiva; Conjunctival Diseases; Diagnosis, Differential; Female; Granuloma, Foreign-Body; Humans; Retrospective Studies
PubMed: 33587421
DOI: 10.1097/IOP.0000000000001950