Glossary

A

Adnexa
[Add-Nex-ah]
Appendages. Structures around the eye that support and surround it (e.g. the eye lids).

Alopecia
[Ah-lo-pee-Sh-ah]
Loss of body hair.

Alternative Treatment
Treatment other than the standard or most common treatment of a condition.

Anesthesia
[Ann-es-Thee-zee-ah]
Absence of normal sensation, usually a drug-induced decreased sensitivity to pain.

Apoptosis
[A-pop-Toh-sis]
A form of cell death where a programmed sequence of events leads to the elimination of cells without releasing harmful substances into the surrounding area.

B

Benefit
[Ben-eh-Fit]
The possibility of improvement (e.g., saving sight and saving life) by use of a diagnostic method or treatment.

Benign
[bee-NI-en]
The tendency to stay the same and not spread to other parts of the body.

Bias
[Bye-ass]
Personal preference not based on facts.

Biopsy
[Bye-op-see]
The removal of tissue, cells or fluids from the body for examination or study.

Brachytherapy
[Bray-key-THER-uh-pee]
Implanted radiation. For example, radiation treatment delivered by a small plaque sewn to the outside of the eye (sclera).

C

Cancer
[Can-sir]
A general term for more than 100 diseases characterized by an abnormal uncontrolled growth of cells. Cancerous tumors can invade and destroy surrounding normal tissues and/or spread to other parts of the body.

CAT Scan (aka computed axial tomography)
[KAT SKann]
An x-ray technique that uses computerized reconstruction to form an image of the inside of the body (head, orbit, chest, abdomen).

Chemotherapy
[KEY-mo-THER-uh-pee]
The use of topical or systemic drugs to treat cancer.

Choroid
[KO-royd]
Layer of normal blood vessels [vascular-layer] of the wall of the eye. The choroid is located between the retina and the sclera.

Choroidal Melanoma
[Ko-ROY-dull Mel-uh-NO-muh]
A malignant tumor (cancer) of the vascular “choroidal” layer of the eye, made up of pigment producing cells (melanocytes).

Chromosome 13
[Kro-moh-Some 13]
The piece of DNA that is responsible for the development of retinoblastoma.

Ciliary Body
[Silly-Airy Body]
An organ located right behind and encircling the iris. Tumors can come from the vascular and non-vascular parts of the ciliary body. The ciliary body also makes fluid which fills the eye.

Clinical Trial
[Klin-ick-al Try-ul]
The systematic investigation of the effects of specific treatments according to a formal research plan.

Complication
[Kom-plick-A-shun]
Undesirable effect of a disease or its treatment that can change the outcome and may require additional treatment.

COMS
Collaborative Ocular Melanoma Study. The largest prospective randomized clinical trial conducted to investigate choroidal melanoma.

Conjunctiva
[Con-junk-Tie-Vah]
A thin membrane that covers most of the outside of the eyeball and inside the eyelids.

Conjunctivitis
[Con-junk-Ti-Vie-tiss]
Inflammation or infection of the thin membrane that covers most of the outside of the eyeball and inside the eyelids.

Cornea
[KOR-nee-uh]
The clear outer portion of the eye which covers the iris and admits light through the pupil.

Cryotherapy
[KRY-oh-THER-uh-pee]
The destruction of tissue or tumor by the application of extreme cold.

Cyclotron
[SY-klo-tron]
A machine which creates high-energy radiation beams.

D

Depth Perception
The ability to recognize 3-dimensional objects and their relative positions in space.

Diagnosis
[dye-egg-NO-sis]
The name of a disease or condition.

Dormant
[DOR-mant]
A relatively inactive or resting condition in which some processes are slowed down or suspended.

Dosimetry
[Doe-si-met-tree]
The act of calculating the amount of treatment (e.g. radiation).

E

Enucleation
[e-noo-klee-AY-shun]
Removal of the eyeball, leaving the eye-muscles and other contents of the eye socket.

Equator
[EE-KWAY-Tore]
A circular position that divides the front from the back portion of the eye.

Eye Wall Resection
[eye-wall ree-SECK-shun]
Removal of the portion of the eye that contains the tumor.

F

Fluorescein Angiography
[FLOR-uh-seen an-jee-OG-ruh-fee]
A test where a vegetable dye is injected into a vein, allowed to circulate within the eye while photographs of the intraocular circulation are recorded.

Fovea
[Foe-Vee-ah]
The center of the macular retina primarily responsible for both color vision and fine resolution (reading vision).

G

General Anesthesia
[JEN-er-ruhl ann-es-THEE-zee-ah]
A complete drug-induced absence of sensation and consciousness induced by an anesthesiologist during surgery.

H

Hemangioma
[Hee-Man-gee-Oh-Ma]
Congental or acquired tumor comprised of blood vessels.

Hemorrhage
[HEM-or-ridge]
Loss of blood, either inside or outside the body.

I

Implant
[Im-Plant]
A device which is placed inside. For example, an implant is placed into the orbit to make up for the loss of the eyeball during enucleation surgery.

Informed Consent
[In-formd Kon-sent]
The process where a patient learns about all the aspects of a medical treatment or clinical trial before agreeing to participate. This process should include a detailed explanation of the potential risks and benefits of all standard medical procedures and treatments.

Interferon
[In-ter-Fear-on]
A immune system modulator used to treat conjunctival and corneal cancers. This chemotherapy drug is either used as an eye drop and/or injected around the tumor.

Iodine-125 Seeds
[I-O-dine 125 seeds]
Rice-sized radioactive sources which are typically purchased and glued within gold eye-plaques for use in treatment of intraocular tumors.

IRB
[Institutional Review Board]
A committee of people who typically reviews, approves or denies the right to conduct a scientific study. IRB’s assure that such studies are ethically and scientifically proper.

Irradiate
[ear-Ray-dee-ate]
To expose part of the body to diagnostic or therapeutic radiation.

J

Juxtafoveal
[Jux-Tah-Foe-Ve-al]
Located next to (touching) the fovea.

Juxtapapillary
[Jux-Tah-pap-hill-airy]
Located next to (touching) the optic nerve.

K

Keratitis
[Ker-ah-tie-tis]
Irritation or inflammation of the cornea. Keratitis can be due to exposure, radiation, infection, or immune reaction.

L

Laser
[LAY-zur]
A very narrow, high intensity, light, which can burn tissue and/or join structures together.

Lens
[Lenz]
A clear structure behind the pupil, which helps to focus light onto the retina.

Local Anesthesia
[LOW-cull ann-es-THEE-zee-ah]
The patient is awake but drugs have been given to decrease or stop sensation in the area of surgery.

Lymphangiectasia
[limf-an-gee-eck-tae-Z-ah]
A dilated lymphatic channel, commonly filled with blood.

M

Macula
[Mack-U-Lah]
The part of the retina responsible for the center of vision.

Malignant
[ma-LIG-nant]
When a tumor contains cancer cells that can spread and cause death.

Melanoma
[mel-uh-NO-muh]
A tumor made up of pigment cells called melanocytes.

Metastasis
[meh-TASS-tah-sis]
The site where the cancer cells have spread to form a tumor.

Metastasize
[me-TAS-tah-size]
The spread of cancer cells from the original tumor to a distant site.

Mitomycin
[My-toe-My-cin]
A chemotherapy drug sometimes used to treat conjunctival and corneal cancers.

Mitosis [Mitotic]
[My-Toe-Sis]
The process when the cell (and its chromosomes) divides.

N

Neovascularization
[Nee-Oh-Vas-Q-lar-eye-zay-shun]
The growth of new blood vessels into, around or within tissue.

O

Ocular
[ock-yu-lar]
Of or pertaining to the eye.

Ocularist
[ock-u-lah-rist]
A specialist who makes and fits artificial eyes.

OD [oculus dexter]
Latin for “right eye.”

Oncologist
[ON-kol-oh-gist]
A general medical doctor who specializes in cancer treatment.

Ophthalmic Oncologist
[off-thal-mick ON-kol-oh-gist]
An ophthalmologist with special training in the diagnosis and management of patients with eye cancer.

Ophthalmologist
[off-thal-mol-loh-gist]
A physician with special training in the medical and surgical treatment of eye diseases.

Optical Coherence Tomography (OCT)
[Op-tic-al Coh-hear-ents Toe-Mah-Graph-E]
Where a laser imaging device is used to image the eye. It can be used to image the front of the eye, but for eye cancers it is most commonly used to observe the retina, choroid and sclera.

Optic Nerve
[OP-tick nurv]
The nerve that sends vision-messages between the brain and the eye.

Optic Neuropathy
[OP-tick nur-Op-ath-he]
Used to describe when the optic nerve appears or functions abnormally.

Orange Pigment
Collections of lipofuscin pigment typically seen on the surface of choroidal melanomas or suspicous choroidal nevi.

Orbital Tumor
[oar-bit-tall TOO-mur]
A benign or malignant tumor behind or around the eye.

OS [oculus sinister]
Latin for “left eye.”

OU [oculus uterque]
Both eyes.

P

Palladium-103 Seeds
[pah-lay-dee-um 103 seeds]
Rice-sized radioactive sources which are typically purchased and glued within gold eye-plaques for use in treatment of intraocular tumors.

PET / CT
[Pah-Zit-tron EE-miss-shun Toe-mog-graph-Fee / Cat-skah-hun]
An imaging study that can provide images of the whole body looking for evidence of cancer.

Photocoagulation
[Foe-Toe-Koe-ah-gu-LAY-shun]
The use of intense light (usually laser-beams) to destroy eye tissues, abnormal blood vessels, and/or tumors.

Pigmentation
[PIG-men-tay-shun]
The color of the body.

Pigmented Cells
[PIG-men-ted sells]
Cells, which are colored and usually contain the natural pigment of the skin or eye, called melanin.

Plaque
[plak]
A bowl-shaped device, which is, or can be made radioactive by adding seeds. An ophthalmic plaque is typically sewn to the wall of the eye in order to treat an underlying intraocular tumor. Plaque therapy is the most common treatment for choroidal melanoma.

Primary Cancer
[PRY-may-ree Kan-ser]
The original malignant tumor from which cells can spread to other parts of the body.

Prognosis
[Prog-NO-sis]
What is most likely to happen over time.

Proptosis
[Prop-Toe-Sis]
When the eye is (displaced) pushed forward from its normal position.

Prosthesis
[pross-thee-sis]
A device that is used to replace the appearance and/or function of a removed organ. For example, the plastic eye that is placed beneath the eyelids to simulate a removed eye.

Proton Beam Radiation
[prote-on beem ray-dee-ay-shun]
Radiation made up of protons, which come out of a machine, travel through the eye into the tumor.

Pupil
[pyoo-pill]
The round opening in the iris which lets light into the eye and onto the retina.

R

Radiation
[ray-dee-Ay-shun]
Energy waves which can be used to diagnose (e.g. chest x-rays) or treat diseases (e.g cancers).

Radiation Oncologist
[ray-dee-AY-shun ON-kol-OH-jist]
A physician with special training in the use of radiation to treat diseases.

Radiation Retinopathy
[ray-dee-Ay-shun RET-in-opp-ah-thee]
When large amounts of radiation cause vascular changes in the normal retina often resulting in decreased vision.

Radiation Therapy
[ray-dee-AY-shun THER-ah-pee]
The use of high-energy radiation to treat cancer and certain benign diseases.

Radioactive Plaque
[ray-dee-OH-ack-tiv plak]
A bowl-shaped radiation device which can be used to treat eye cancers (e.g. melanomas and retinoblastomas).

Randomization
[RAN-dum-eye-ZAY-shun]
The process of assigning patients to two or more treatment options, where each patient has an equal chance of receiving each treatment.

Retina
[REH-tin-uh]
The nerve tissue which lines the inside of the eye and acts like the film inside a camera.

Retinoblastoma
[Ret-in-OH-blast-OH-mah]
A cancerous tumor of the retina which typically affects children under 5 years of age. Retinoblastoma is the most common malignancy to start within the eye of children.

Risks
The possibility of loss or injury resulting from a condition or treatment.

S

Sclera
[SKLEHR-uh]
The white outer wall of the eye.

Scotoma
[SkoH-Toe-Mah]
A blind-spot or defect in the field of vision.

Side Effect
An unwanted effect of treatment.

Standard Treatment
The accepted, recognized and commonly used form of therapy. What is typically used by most physicians treating a particular disease.

Stereopsis
[Stay-re-op-sis]
The ability to see objects with depth perception from both eyes.

T

Teratogenic
[Tear-at-Oh-gen-ick]
The tendency to induce birth defects.

Tumor
[TOO-mur]
A mass of tissue characterized by thickness or volume.

U

Ultrasonography (Ultrasound)
[UL-trah-SO-nah-gra-fee]
The use of sound waves to examine the eye and orbit. Ultrasonography is commonly used to measure the size of tumors.

V

Vascular
[VAS-ku-lar]
Containing blood vessels.

Visual Field
[VIZ-yoo-ul FE-eld]
The complete area of vision that includes what is seen above, below, to the sides and in the center.

Vitreous
[VIT-tree-us]
The jelly-like substance which fills most of the normal eye.

Vitreous Seeding
[VIT-tree-us See-Ding]
Small pieces of tumor can break off “seed” and float around inside the eye.

Benign Eyelid Tumors – Nevus at the Eyelid Margin

By Paul T. Finger, MD

Description

A nevus (a benign tumor) is commonly found on the skin of other parts of the human body. A nevus can also occur on the eyelid skin. These tumors are usually pigmented and have thickness.

Symptoms

Benign Eyelid Tumors - Nevus at the Eyelid Margin
Note the relatively smooth surface, no eyelash loss, a long history of its presence, and no history of recent growth. Nevi can be melanotic “dark” like this one, or amelanotic “light-colored.” *Note* Some nevi grow during puberty.

Patients typically notice a dark spot on their eyelid that is thickened. It usually does not cause loss of eyelashes and though it can grow, most do not. When rapid (over months) growth, loss of eyelashes or discoloration of the nevus is noted, malignant melanoma is suspected.

Diagnosis

Most eyelid nevi can be diagnosed by clinical examination. A baseline photograph should be obtained for comparison with future examinations. Very suspicious or rapidly growing eyelid nevi should be biopsied to rule out melanoma. It is important to note that eyelid nevi can slowly grow, and that change is particularly common during puberty.

Treatments

Eyelid nevi are benign tumors. They can be photographed and followed for evidence of change or growth prior to consideration of biopsy or treatment. Large eyelid nevi can be a cosmetic problem that can be repaired by ophthalmic plastic surgery.

Related links

Benign Eyelid Tumors – Hydrocystoma

By Paul T. Finger, MD

Description

The benign eyelid tumor hydrocystoma comes from the Latin hydro, meaning fluid, and cystoma, meaning cyst or sac.

A hydrocystic thickening is an epithelial-lined serous cyst (within the skin or soft tissues). Sometimes it looks like they are translucent.

Symptoms

An intradermal epithelial-lined serous cyst.

Hydrocystomas most commonly occur on the eyelids. They typically are the same color as eyelid skin, rounded and soft to the touch. They are slow growing, may cause misdirection but not loss of eyelashes.

Diagnosis

Hydrocystoma is a benign tumor that can be photographed and followed for evidence of growth. High-frequency ultrasound can demonstrate that the tumor is filled with fluid and confirm the diagnosis.

Treatments

Excision is typically performed if growth is documented, basal cell or other eyelid cancer is suspected and for cosmetic reasons. During removal, your surgeon will try and keep the cyst intact. Removing the whole tumor will help keep it from recurring.

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Benign Eyelid Tumors – Capillary Hemangioma

By Paul T. Finger, MD

Description

These tumors typically grow and then spontaneously decrease in size.
These tumors typically grow and then spontaneously decrease in size.

Congenital “strawberry-spot” which usually will spontaneously get smaller “involute.”

Treatment is indicated for the prevention of amblyopia (loss of vision) and strabismus (misdirected eyes). These tumors naturally grow and then spontaneously decrease in size. Therefore, if the tumor is not harming the child, it can be observed untreated for spontaneous regression.

Symptoms

Capillary hemangiomas are typically found at birth. They will grow during the first decade (10 years) and most will shrink (involute). If they involve the eyelids, they can cover the eye and cause loss of vision (amblyopia). It is very important that children with capillary hemangiomas be seen by a pediatric ophthalmologist and eye cancer specialist immediately.

Diagnosis

Capillary hemangioma is diagnosed by clinical examination. It has a typical appearance and biopsy is rarely needed. It appears as a reddish tumor or mass beneath the skin. The eye care specialist will order a radiographic scan (MRI or CT) to see how deep the tumor extends into the orbit (around the eye). The child’s pediatrician should be advised and the child inspected for hemangiomas on other parts of the body.

Treatments

Observation for spontaneous resolution is commonly performed. If the tumor is blocking the eye and vision causing amblyopia, then it can be treated with an oral beta-blocker medication (e.g. propranolol) or injected with a steroid solution. This will shrink the tumor in an effort to uncover the eye. Surgery may be required to remove very large tumors. The child’s pediatric ophthalmologist may suggest that the other “good” eye be periodically covered with a patch to strengthen the tumor affected eye and prevent amblyopia-related vision loss.

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Basal Cell Carcinoma (Eyelid Cancer)

By Paul T. Finger, MD

Description

A basal cell carcinoma anterior to the medial canthus: Note the pearly margins and the central crater.
A basal cell carcinoma anterior to the medial canthus: Note the pearly margins and the central crater.

The most common type of eyelid cancer is basal cell carcinoma. Most basal cell carcinomas can be removed with surgery. However, many older patients will try to ignore these slow growing tumors. However, it is important to know that when left  untreated, these tumors can grow around the eye and into the orbit, sinuses and brain. Basal cell carcinomas are more commonly found on the lower eyelids and almost never spread to other parts of the body (metastasize).

Symptoms

Patients with basal cell carcinomas most commonly notice a reddish nodule slowly forming on their eyelid. The tumor is most commonly found on the lower eyelid, followed by the medial canthus (skin toward the nose) and can occur on the upper eyelid. Eyelash loss (around the tumor) suggests that a basal cell carcinoma is malignant.

Less commonly, basal cell cancers can be pigmented or present without any nodule at all. When the tumor does not make a nodule and grows within the eyelid, it can induce pulling of the eyelid (away from the eye). Doctors call this form of basal cell carcinoma “morpheaform,” which are much more difficult to cure because its edges are harder to define.

Diagnosis

Though small tumors can be photographed and followed for evidence of growth (prior to biopsy); once your eye cancer specialist suspects basal cell carcinoma, most eye cancer specialists will suggest tumor biopsy. This specimen is sent to the pathologist to confirm the diagnosis prior to complete removal or treatment of the tumor. Biopsies can be performed in the doctor’s office, or in the operating room prior to definitive treatment.

Treatments

Once the diagnosis is confirmed by the pathologist, treatment will be recommended. Wedge resection and Moh’s surgery require the surgeon continue to remove the tumor until the margins (edges) are negative (free of tumor). Unlike most skin, the eyelid are a complex functional apparatus that requires special reconstruction techniques.

Most basal cell carcinomas are cured when they are small. Unfortunately, some patients choose to ignore or deny the existence of these tumors. Those patients allow their tumor to invade behind the eye and become difficult or impossible to remove. In these cases, combinations of surgery, radiation and chemotherapy may be required to control or destroy the tumor.

Additional Info

This is a sun related cancer. Dr. Finger suggests, “Think of sunglasses as sunblock for your eyes”™

Related Links

Search Recent Scientific Publications about Basal Cell Carcinoma of the Eyelids

Squamous Carcinoma and Intraepithelial Neoplasia of the Conjunctiva

By Paul T. FInger, MD

Description

Squamous conjunctival neoplasia (SCN) is most commonly found in older white males (76%). The average age of patients affected by SCN is 56. This tumor, said to make up 14% of all primary ocular and orbital tumors is related to sun exposure. Sunlight, particularly ultraviolet-B (UV-B) radiation can cause DNA damage, mutations, and cancerous cells. Though human papillomavirus -16 has been found in conjunctival tumor specimens, it has not been proven to cause this tumor. The immunosuppressed (e.g. elderly, HIV positive) are particularly vulnerable. When conjunctival squamous carcinoma occurs in HIV positive patients, it can be particularly resistant to treatment.

Symptoms

Patients notice a white or yellow-white tumor on the surface of the eye (often with extension onto the cornea).

Diagnosis

Squamous conjunctival neoplasia tends to be found between the eyelids (interpalpebral space), and at the limbus (border of the white sclera and clear cornea). This tumor can extend onto the cornea, around the limbus, and rarely into the eye and orbit. When the tumor extends onto the cornea it can be avascular and opaque in appearance. Commonly, squamous conjunctival neoplasia will contain characteristic corkscrew-shaped blood vessels.

Squamous Conjunctival Carcinoma: Note the white nodular thickening at the limbus.

Nodular Squamous Conjunctival Carcinoma:  There is also a nodular type that is  circumscribed, rapidly growing, and invasive. Since this type more commonly extends beneath the conjunctival epithelium, nodular tumors exhibit increased metastatic potential. All large squamous conjunctival cancers should be examined with high frequency ultrasound. This technique can be used to determine if the tumor has invaded the eye or orbit.

In the image on the middle right, note that a few corkscrew-shaped blood vessels on its surface (arrow).

Diffuse Squamous Conjunctival Carcinoma:

Nodular Squamous Conjunctival Carcinoma: Note that a few corkscrew-shaped blood vessels on its surface (arrow).

There is a diffuse variant that can masquerade as chronic conjunctivitis. Tumor thickening occurs late making it difficult to diagnose. Therefore, a conjunctival biopsy should be considered in cases of conjunctivitis lasting more than 3 months.

The diagnosis of malignant squamous conjunctival neoplasia is typically made by biopsy. Like most squamous epithelial tumors, invasion beneath the epithelium into the substantia propria defines these lesions as carcinoma. This is because, when the tumor is contained within the epithelium it does not have access to the lymphatic system or metastatic potential.

Treatments

Every suspected squamous conjunctival cancer should be photographed and AJCC staged prior to biopsy or excision. Surgical excision (alone) has been associated with high rates

The diagnosis of squamous conjunctival neoplasia is typically made by biopsy.

of recurrence. This is because the tumor’s edges and deep margins are either gray or the same color and the sclera and thus difficult to determine. When the tumors edges are clear and avascular, it leads to a false sense that the tumor is smaller than it is.

Local superficial freezing of the tumor bed, sclera and adjacent conjunctiva (cryotherapy) has improved local control and decreased the incidence of tumor recurrence. Other centers have added radiation therapy to decrease tumor recurrence.

However, topical chemotherapy is becoming the most common method of treatment.

While a large clinical trial is needed to compare the effectiveness of topical chemotherapy to excision and cryotherapy, Dr. Finger now uses topical chemotherapy eye drops to avoid surgery (in most cases).

Additional info

Local Spread:

Intraocular spread of squamous conjunctival neoplasia is rare in developed countries (< 5% of cases). When intraocular penetration occurs it is typically through the limbus. Signs include neovascularization of the iris and cornea as well as glaucoma, and peripheral anterior synechiae. Dr. Finger has found high frequency ultrasound to be particularly helpful in these cases.

High frequency ultrasound is particularly helpful in these cases. Positive findings include: thickening of the ciliary body, uvea and blunting of the iridocorneal angle. Intraocular penetration is typically treated by deep cryotherapy, eye-wall resection or radiation.

If the orbit is invaded, there is a risk of spread into the sinuses and brain. Such invasion is said to be the most common cause of death related to this tumor. When squamous conjunctival neoplasia metastasizes beyond the eye and orbit, it can either be found in the regional lymph nodes (preauricular, submandibular, and cervical), or in the lungs and bone.

In general, early detection allows for removal or destruction of these tumors with excellent local cure rates.

Risk Factors:

  • Fair Skin
  • Tendency to Sunburn
  • Outdoor Occupation
  • Living Close to the Equator
  • History of Actinic Skin Lesions
  • Xeroderma Pigmentosum
  • Immunosuppression
  • Male Gender
  • Older Age

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Pterygium

By Paul T. Finger, MD

Description

A nasal pterygium is noted to extend onto the cornea.
A nasal pterygium is noted to extend onto the cornea.

Pterygium is a vascular pink tissue that can grow from the conjunctiva onto the cornea. If it grows into the line of vision (over the pupillary aperture), it can interfere with vision. Pterygium are most commonly found to originate from on the inner (nasal) surface of the eye, and extend toward the the pupil. They can also occur the on the temporal (towards the ear) side of the eye.
Pterygium are more common in countries near to the equator, where there is long-term exposure to sunlight, particularly ultraviolet (UV) rays. In addition, others believe that chronic eye irritation may play an important role. Therefore, pterygium occur more often in people who spend time outdoors, particularly in sunny climates.
Pterygium are benign (not malignant) tumors. Hence pterygium do not invade the eye, sinuses or brain. Pterygium do not spread to other parts of the body (metastasize).

Symptoms

Pterygium are external to the eye, visibly apparent, and typically noted to grow before they cause symptoms. They can become irritated, causing an itchy, burning sensation. If allowed to grow into the line of vision (pupillary axis), then a pterygium can cause impairment of vision.

Diagnosis

Pterygium is usually diagnosed based on appearance. They are typically a wing-shaped, soft tissue growth from the nasal or less commonly the temporal bulbar conjunctiva toward the cornea. Should growth be documented, excision is usually suggested. When surgery is performed, the excised tissue should be sent to pathology for a histopathologic diagnosis.

Treatments

This pterygium has progressed over the visual (pupillary) axis and is affecting the patient's vision.
This pterygium has progressed over the visual (pupillary) axis and is affecting the patient’s vision.

If a pterygium becomes red and irritated, lubricating eye drops or ointments can be placed onto the eye as to reduce the inflammation. Rarely, anti-inflammatory eye drops may be prescribed.

Pterygium are surgically removed when they affect sight, grow such that your eye care professional expects it to impair vision, or if it is cosmetically unacceptable. Unfortunately, pterygium may return despite proper surgical removal. To help prevent recurrences surface radiation, conjunctival implants (grafts), or chemotherapy medications can be used.

Patients with pterygium should wear ultraviolet (UV) protective sunglasses, use artificial tears, and avoid dry and dusty conditions.

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Pingueculum

By Paul T. Finger, MD

Description

A pingueculum is a yellowish patch on the white (sclera) of the eye. Found between the eyelids, it is most often on the nasal side (closest to the nose), but can be found on the temporal (closest to the ear) side. Pingueculum are not cancer. It is a sun-related alteration of the normal conjunctival tissue.

Pingueculum.
Pingueculum with thickness: Note the lack of intrinsic vascularity or corneal extension.

Symptoms

Pingueculum are usually visible, found on the surface of the eyeball, between the eyelids. They can become a cosmetic problem, rarely become inflammed, irritated and red. When this happens, the patient may have a feeling like there is something (a foreign body) on the eye.

Pingueculum can become thickened. But, it should not have prominent or corkscrew-shaped blood vessels (within the tumor), nor should the pingueculum extend onto the cornea.

 

Diagnosis

An eye care professional can diagnose a pingueculum by clinical “slit-lamp” examination.

 

Treatments

Eye care professionals typically leave pinguecula alone. If it becomes irritated, it can be treated with a topical non-steroidal or steroid eye drop. Artificial tears are also helpful. Surgery is reserved for atypical pingueculum or when another “cancerous” diagnosis is suspected.

Pigmented Conjunctival Cancers (Primary Acquired Melanosis)

By Paul T. Finger, MD

Description

Malignant melanomas can start as a nevus/freckle or arise as newly formed conjunctival pigmentation called primary acquired melanosis (PAM).

A simple biopsy can determine whether a pigmented conjunctival tumor is a nevus, primary acquired melanosis, or conjunctival melanoma. As seen below, primary acquired melanosis typically affects one eye, in middle-aged, fair-skinned people.

In contrast, darkly pigmented individuals often have naturally occurring pigment on their conjunctiva. When this occurs it is called racial melanosis. Unlike primary acquired melanosis, racial melanosis tends to involve both eyes and is typically present for the entire life of the patient.A simple biopsy can determine whether a pigmented conjunctival tumor is a nevus, primary acquired melanosis, or conjunctival melanoma. As seen above, primary acquired melanosis typically affects one eye, in middle-aged, fair-skinned people.

Symptoms

Pigmentation of the surface of the eye and/or eyelids.

Diagnosis

Most pigmented spots on the eye are benign. Your eye care specialist can take a photograph of them and watch to see if they change prior to consideration of biopsy or treatment.

Pigmented conjunctival tumors that are raised, hypervascular, or extend onto the cornea are considered suspicious. Though suspicious conjunctival tumors can be biopsied after your first visit to the eye cancer specialist, close observation for evidence of growth (prior to biopsy) may also be recommended. Documented tumor growth is a strong indicator that biopsy should be performed.

Once the biopsy is performed, the specimen should be evaluated by an ophthalmic pathologist. If there is no ophthalmic pathologist at your center, the slides can be sent for second opinion.

A pigmented conjunctival nevus can be photographed and followed for evidence of growth prior to biopsy or excision. It is important to note that both benign and malignant tumors can grow (though malignant tumors will grow faster).

Slit-lamp photography of benign conjunctival lesions is helpful in determining if subsequent change has occurred. It is a good idea for the patient to have a copy of the initial photograph because doctors are not required to keep medical records indefinitely, and the lesion can change even years after the initial diagnosis.

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Search the Scientific Literature on Pigmented Conjunctival Tumors

Melanoma In Situ and Invasive Conjunctival Melanoma

By Paul T Finger, MD

Description

Primary acquired melanosis with atypia (biopsy proven).

Malignant melanoma can occur on the surface of the eye (conjunctiva and cornea). It can start on its own, as a pre-existing nevus or arise within newly formed pigmentation.

 

Symptoms

Most patients notice either a nodule forming on, or a darkening of the surface of the eye. Large tumors can bleed resulting in “bloody tears.” The tumor can extend onto the eyelid skin and lymph nodes in front of the ear (preauricular) or neck (cervical). Involved lymph nodes enlarge and can be felt (palpable) during examination.

 

Diagnosis

The doctor will examine your eyes. This includes an examination of all the conjunctival surfaces (including the inside of the eyelids). Pigmented conjunctival tumors are considered suspicious if they have large blood vessels running toward them, if they extend onto the cornea or if they extend into the conjunctival fornices.
Photographs should be taken of all the conjunctival and corneal surfaces at the time of initial examination (prior to any biopsy). This is important because it helps the doctor document the extent of the condition (stage the tumor) and can be used to plan for surgery and aid in follow up. Removing a conjunctival melanoma prior photography and/or referral to an eye cancer specialist can decrease the patients chance for cure.

Biopsy can determine whether a pigmented conjunctival tumor is a nevus, primary acquired melanosis, or conjunctival melanoma. A conjunctival nevus and benign acquired melanosis can be photographed and followed for evidence of change prior to intervention. Malignant conjunctival melanoma and intra-epithelial melanoma (in situ) should be removed or destroyed.

*Note* In a multicenter international effort to develop a staging system for conjunctival melanoma, the authors agreed that the term Primary acquired melanosis with atypia should be abandoned in favor of conjunctival melanoma in situ.

 

Treatments

Most very small areas of conjunctival hyperpigmentation can be photographed and followed for evidence of growth or change prior to treatment. If they are raised, hypervascular or extend onto the cornea a biopsy is reasonable. Small tumors can be completely removed, and if they are found to be malignant additional cryotherapy (freezing) or adjuvant topical chemotherapy may be necessary.

Melanomas can be difficult to treat if they occur at multiple spots on the eye. In these cases, surgical removal with freezing therapy may not control this tumor. Then chemotherapy eye-drops can be used for patients with conjunctival melanoma. Chemotherapy eye drops treat the entire surface of the eye, and is less dependent upon defining the tumors edges.

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