Ocular surface squamous neoplasia (OSSN) refers to a broad range of precancerous and cancerous lesions that affect the cornea and conjunctiva.1 The etiology of OSSN is multifactorial, likely involving a variety of environmental factors in a susceptible host. Exposure to ultraviolet light has been implicated as a potential risk factor.2 In the Western Hemisphere, OSSN is diagnosed most commonly in men aged 60 to 70 years who live close to the equator.3 Furthermore, epidemiologic surveys have identified a higher prevalence of cases in geographic areas closer to the equator.4
Presentation
A 59-year-old Caucasian male presented with right eye redness and irritation. Past ocular history was significant for optic neuropathy in both eyes and migraines with visual aura. Other medical history included arrhythmia and basal cell carcinoma (treated with fluorouracil). He reported that he was an avid sailor with occasional use of sunscreen. Anterior Segment OCT (AS-OCT) of the right eye showed hyperreflectivity, epithelial thickening, and presence of an abrupt transition zone corresponding to a corneal lesion seen in an external photo (Figure 1). The patient was diagnosed with OSSN.
Figure 1. External photo and AS-OCT of the right eye showing a conjunctival lesion and a peripheral corneal opacity temporally.
Treatment
The patient was treated with 3 cycles of 5 fluorouracil QID for 1 week followed by a 3-week break, then 3 cycles of MMC 0.04% QID for 4 weeks followed by 2 weeks off. An external photo of the right eye showed complete resolution of the corneal lesion and AS-OCT demonstrated the absence of hyperreflectivity (Figure 2).
Figure 2. External photo of the right eye and AS-OCT demonstrating absence of conjunctival lesion and corneal opacity.
Summary and Discussion
This is a rare case of OSSN in a patient with known sun exposure and history of basal cell carcinoma which completely resolved following treatment with topical fluorouracil and MMC. Of note, partial resolution was demonstrated following fluorouracil, but the lesion completely resolved after the 3 cycles of MMC. This management plan is, to our knowledge, novel in patients with OSSN. Resolution of the lesion following treatment (~8 months) was demonstrated in the external photos along with AS-OCT scans.
1. Gurnani B, Kaur K. Ocular Surface Squamous Neoplasia. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK573082/
2. Krachmer JH, Mannis MJ, Holland EJ. Cornea: Fundamentals, diagnosis and management. 2005.
3. Basti S, Macsai MS. Ocular surface squamous neoplasia: a review. Cornea. 2003;22:687-704.
4. Karp CL, Scott IU, Chang TS, Pflugfelder SC. Conjunctival Intraepithelial Neoplasia: A Possible Marker for Human Immunodeficiency Virus Infection? Arch Ophthalmol. 1996;114:257-261.
