Online Photo Diagnosis

By Gregory W. DeNaeyer, OD, FAAO

This photograph shows a conjunctival intraepithelial neoplasia (CIN) in a 67-year-old white male patient's left eye. The patient reported noticing a growth on his affected eye that started six weeks prior to his examination. His previous ocular history was unremarkable. The patient systemically had a history of leukemia that was currently in remission. His visual acuity in the left eye was 20/20. Slit lamp examination showed a 5mm × 6mm inferior fleshy growth of his conjunctiva that was vascularized. A similar lesion that measured 5mm × 3mm was located nasally to the cornea. The patient was diagnosed with a CIN of his left eye and was prescribed mitomycin C 0.02% ophthalmic solution q.i.d. for one week. Then after being off the drops for one week, he was instructed to use them again q.i.d. for one week.

CIN are precancerous lesions of the conjunctiva that can develop into squamous cell carcinomas. They are most commonly diagnosed in elderly patients. Treatment may involve the application of chemotherapeutic agents and/or excisional biopsy along with cryotherapy. Patients are at an approximately 12 percent risk of limbal stem cell deficiency when using mitomycin C 0.04% topically (Russell 2010). It is thought that reducing the concentration of mitomycin C can lower this risk.

In this particular case, most of the patient's lesion resolved after finishing the mitomycin C regimen. The remaining tissue was excised and treated with cryotherapy. The patient was retreated with mitomycin C two years later secondary to a possible recurrence.

References

1. Cullom, RD. Chang, B. The Wills Eye Manual. J.B. Lippincott Company 1994.
2. Russell, HC. Chadha, V. Lockington, D. Kemp, EG. Topical mitomycin C chemotherapy in the management of ocular surface neoplasia: a 10-year review of treatment outcomes and complications. Br J Ophthalmol 2010 Oct;94(10):1316-21.