Benign tumors of the conjunctiva and cornea

Tumors of the conjunctiva and the cornea are considered together, since the epithelium of the cornea topographically is the continuation of the epithelium of the conjunctiva. The rich connective tissue base of the conjunctiva predisposes to the emergence of a wide range of tumors.

In the conjunctiva and the cornea, benign tumors (dermoids, dermolipomas, pigmentary tumors) prevail, and in childhood they constitute more than 99% of all tumors of this localization.

[1], [2], [3], [4], [5],

Conjunctival dermoid

The dermoid of the conjunctiva refers to the developmental anomalies (choristomas); is about 22% of all benign conjunctival tumors in children. The tumor is revealed in the first months of life. It is often combined with the developmental defects of the eyelids, can be bilateral. When microscopic examination in the formation of elements of sweat glands, fat lobules, hair. Dermoid - formation of a whitish-yellow color, more often located near the outer or lower-limb limb. With this localization, the tumor spreads to the cornea early and can grow to its deep layers. Expanded vessels fit the neoplasm. The surface of the dermoid on the cornea is smooth, shiny, white in color. Dermolipoma - a dermoid with a high fat content, is more often localized in the area of arches of the conjunctiva. Treatment of conjunctival surgical dermoid.

[6], [7], [8], [9]

Papilloma of the conjunctiva

Papilloma of the conjunctiva often develops in the first two decades of life, can be represented by two types. Tumor of the first type is observed in children; it manifests itself in multiple nodules, more often localized in the lower arch of the conjunctiva. Individual nodules can be observed in the conjunctiva of the eyeball or on the semilunar fold. Nodules translucent with a smooth surface, consist of individual lobes, permeated with their own vessels, which gives them a reddish-pink color. A soft consistency and a thin base in the form of a foot makes the nodules mobile and lightweight: their surface bleeds even with a light touch with a glass rod. In older patients, horny papilloma (the second type), as a rule, is localized near the limb in the form of a single fixed formation of grayish-white color. Its surface is rough, the lobules are hardly distinguishable. With this localization, the papilloma extends to the cornea, where it has the appearance of a translucent formation with a grayish hue. Papilloma of the first type is microscopically represented by non-cornificating papillary growths, in the center of which there are vascular loops. Such papillomas can spontaneously regress. Given the multifocal nature of the lesion, their surgical treatment is often ineffective; The laser evaporation or application of 0.04% solution of mitomycin C on the affected area is shown. For horny papilloma (the second type) is characterized by papillary hyperplasia of the epithelium with pronounced para- and hyperkeratosis. Such a papilloma is subject to laserexcision, since cases of its malignancy are described. With complete removal of the tumor, the prognosis is good.

Bowen's epithelioma

Bowen's epithelium is identified, as a rule, in the fifth decade of life and later, more often in men. Usually the process is one-sided, monofocal. Etiologic factors include ultraviolet irradiation, prolonged contact with products of oil refining, the presence of human papillomatous virus. The tumor is a flat or slightly projecting above the surface of the conjunctiva plaque with clear gray boundaries, with pronounced vascularization may have a reddish tinge. Bowen's epithelium appears in the epithelium, can penetrate into the deep layers of the conjunctiva, but the basal membrane always remains intact. Spreading on the cornea, the tumor does not germinate the Bowman membrane (anterior border plate). Treatment is surgical or combined, including treatment of the tumor with 0.04% solution of mitomycin C 2-3 days before the surgery, excision of the tumor and treatment of the operating wound with a solution of mitomycin C on the operating table and in the next 2-3 days. Short-distance X-ray therapy is effective.

[10], [11], [12], [13]

Vascular tumors of the conjunctiva

Vascular conjunctival tumors are represented by capillary hemangioma and lymphangioma; belong to the group hamartom, observed from birth or manifested in the first months of life. Capillary hemangioma is more often localized in the inner corner of the eye gap, consists of sharply convoluted bluish vessels of small caliber that infiltrate the semilunar fold and conjunctiva of the eyeball. Spreading on the vaults, the vessels can penetrate into the orbit. Spontaneous hemorrhages are possible. The treatment consists of a dosed submerged electrocoagulation. Laser coagulation is effective at an early stage.

Lymphangioma of the conjunctiva

Lymphangioma of the conjunctiva occurs much less often than hemangiomas, is represented by dilated thin-walled vascular channels of irregular shape, the inner surface of which is lined with endothelium. These channels contain a serous fluid with an admixture of erythrocytes. The tumor is localized in the conjunctiva of the eyeball or its arches. In the process, a half-moon fold and teardrop are involved. The tumor looks like a translucent yellowish thickening of the conjunctiva, consists of small lobes filled with a clear liquid, sometimes with a trace of blood. On the surface of the lymphangioma, small hemorrhages are often seen. In the lobules and between them there are blood vessels filled with blood. The tumor infiltrates the soft tissues of the orbit. Small, non-common lymphangiomas can be cured with a CO ₂ laser. With more common tumors, brachytherapy can be recommended using a strontium applicator with the removal of the cornea from the irradiation zone.

Conjunctival nevi

Nevus conjunctiva - pigmented tumor of the conjunctiva - is 21-23% of its benign neoplasms. It is first detected in childhood, less often in the second and third decades of life. The clinical course of nevi is divided into stationary and progressive, blue nevus and the primary acquired melanosis.

A stationary nevus of the conjunctiva is detected in young children. Favorite location - the conjunctiva of the eyeball in the eye area, never arises in the mucous membrane of the eyelids. The color of the nevus is from light yellow or pink to light brown with a well-developed vascular network. Usually the tumor is located near the limbus. Up to 1/3 of the stationary nevuses are pigment-free. At pubertal age, the color of the nevus can change. The surface of the tumor is smooth or slightly rough due to the formation of small light cysts in it, the boundaries are clear. When the eyeball is localized in the conjunctiva, the nevuses easily move over the sclera, while the limbs are immovable. Nevi, localized in the area of the semilunar fold and teardrop, are found, as a rule, in adults. They are often more intensely pigmented (color ranging from light to intensively brown). Often cases of focal pigmentation, especially nevi, located in the area of the lacrimal flesh. The semilunar fold in the nevus is thickened, and in the region of the lacrimal flesh, the tumor slightly predominates. Its boundaries are clear.

The progressive nevus is characterized by an increase in size, a discoloration. The surface of the nevus looks mottled: along with pigmentless or weakly pigmented areas, areas of intense pigmentation appear, the boundaries of the tumor become less distinct due to the pigment dispersion. The accumulation of pigment can also be observed outside the visible boundaries of the tumor. Significantly expand their own vessels of the tumor, increasing their number. The presence of a triad of signs - enhancement of pigmentation, vascularization of nevi and border blurring - allows to differentiate the true profession of the tumor from its increase due to reactive hyperplasia of the epithelium. Limitation of the displacement of the nevus in relation to the sclera is a late symptom that shows the development of melanoma. Border nevus is more often diagnosed in children, mixed, especially localized in the field of teardrop, in adults. Treatment - excision of the nevus - is indicated when signs of its growth appear. According to the latest information, the incidence of malignancy of conjunctival nevi reaches 2.7%.

The blue (cellular) nevus of the conjunctiva is an inborn formation, which is extremely rare. It is considered as one of the symptoms of systemic damage to the skin of the oculodermal region. With a blue nevus, the conjunctiva of the eyeball, unlike the skin, is colored brown. The formation is flat, reaches a large size, does not have a clear shape, but its boundaries are well delineated. Blue nevus can be combined with melanosis. Treatment is not required, since malignant variants of blue nevus in the conjunctiva are not described.

[14], [15], [16]

Primary acquired conjunctival melanosis

The primary acquired melanosis (PPM) of the conjunctiva, as a rule, is one-sided. A tumor occurs in middle age; can be localized in any part of the conjunctiva, including in the arches and palpebral part. In the process of growth of the primary acquired melanosis, the appearance of new pigmentation zones is characteristic. Foci of the primary acquired melanosis are flat, with fairly distinct boundaries, have an intensely dark color. Reaching the limb zone, the tumor easily spreads to the cornea. Treatment consists in extensive laser coagulation or electroexcision of the tumor with preliminary applications of 0.04% solution of mitomycin C. With a small spread of the primary acquired melanosis, a good result is provided by cryodestruction. In cases of damage to the arches and the tarsal conjunctiva, brachytherapy is more effective. The prognosis is unfavorable, since in 2/3 cases the primary acquired melanosis undergoes malignancy.